The prevalence of rectal cancer is on the rise, particularly among the elderly population, as the aging demographic grows. This increase in cases has led to a growing discussion about the suitability of surgical interventions for older patients, who are often underrepresented in surgical studies. The study in question examines the feasibility of robotic surgery, specifically the Da Vinci surgical system, for patients aged 70 years and older diagnosed with rectal cancer. By gathering data from multiple databases, including PubMed, Embase, Scopus, and the Cochrane Library, the researchers aim to analyze the practicality and outcomes of robotic surgery in this demographic, focusing on various postoperative outcomes.

Methodology and Data Collection

The researchers conducted a thorough review of existing literature to collect data relevant to their study. They executed a systematic search across several databases, adhering to the PRISMA guidelines for meta-analysis. Their criteria included only human studies published in English, while excluding animal experiments, case studies, reviews, and letters that did not compare outcomes between elderly and younger patients. The analysis utilized the MINORS assessment tool to evaluate the quality of the included studies, and statistical analysis was performed using RevMan 5.4 to assess various outcomes such as harvested lymph nodes, body mass index (BMI), and postoperative complications.

Patient Characteristics and Findings

The review identified a total of 890 patients from five studies, with 240 categorized as elderly and 650 as younger patients. The results indicated significant differences in certain outcomes, such as the number of harvested lymph nodes and BMI between the two groups. However, other factors like the length of hospital stay and the Clavien–Dindo classification for complications did not demonstrate significant differences. Despite the risks associated with increased age, the analysis suggests that frailty, rather than age alone, is a more critical factor influencing postoperative outcomes.

Analysis of Postoperative Outcomes

The study analysed various postoperative outcomes, including the number of harvested lymph nodes, complications classified by the Clavien–Dindo system, and the length of hospital stays. The findings revealed that the elderly group had a statistically significant difference in the number of harvested lymph nodes, favouring the elderly over younger patients. In terms of complications, while the trend indicated a higher incidence in the younger group, the differences were not statistically significant. Regarding hospital stays, there was no significant difference between the elderly and younger groups, suggesting comparable recovery patterns.

Discussion on Surgical Feasibility and Patient Outcomes

The discussion highlights the critical role of rectal cancer surgeries, which are essential yet fraught with potential complications, particularly in older patients. The analysis emphasizes that older patients often face barriers to receiving surgical treatments due to concerns about comorbidities and postoperative outcomes. Despite these concerns, the study found that robotic surgery is well-tolerated in patients over 70, reiterating the importance of considering overall health rather than age alone when evaluating treatment options. The findings support the notion that robotic surgery can be a viable option for elderly patients, contributing to better postoperative outcomes.

Conclusion and Implications for Future Research

In conclusion, while age is a factor associated with increased postoperative risks, the evidence from this study highlights frailty as the primary determinant of surgical outcomes. This reinforces the idea that older patients should not be excluded from potentially beneficial surgical interventions solely based on age. The study calls for comprehensive preoperative assessments to ensure that elderly patients can access robotic surgical options safely. Future research should continue to investigate the impact of frailty on surgical outcomes and further explore the role of robotic surgery in improving the quality of life for elderly patients with rectal cancer.

SOURCE: https://link.springer.com/article/10.1007/s11701-024-02210-3

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