Robot-assisted vs. laparoscopic right hemicolectomy in octogenarians and nonagenarians: an analysis of the US nationwide inpatient sample 2005–2018

• Published in: Aging clinical and experimental research 2024-09, Vol.36 (1), p.193, Article 193
• Main Authors: Lu, Chien-Chang, Lu, Chi-Tung, Chang, Kai-Yen, Chun-Li, Wang, Wu, Chien-Ying
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Colectomy - methods; Colonic Neoplasms - mortality; Colonic Neoplasms - surgery; Female; Geriatrics/Gerontology; Hospital costs; Humans; Inpatients; Laparoscopy; Laparoscopy - methods; Laparoscopy - statistics & numerical data; Length of Stay; Male; Medicine; Medicine & Public Health; Postoperative Complications - epidemiology; Regression analysis; Retrospective Studies; Robotic Surgical Procedures - methods; Robotic Surgical Procedures - statistics & numerical data; Robots; Treatment Outcome; United States - epidemiology
• ISSN: 1720-8319; 1594-0667; 1720-8319
• DOI: 10.1007/s40520-024-02833-4

Background Colorectal cancer (CRC) is a significant health concern, particularly among older adults. Outcomes between laparoscopic and robot-assisted surgeries for right-sided colon cancers in the oldest old population have yet to be evaluated despite increased use of these surgeries. Aim This study aimed to compare clinical outcomes after robot-assisted right hemicolectomy (RARH) versus laparoscopic right hemicolectomy (LRH) in octogenarian and nonagenarian patients. Methods This population-based, retrospective and observational study analyzed the data of adults ≥ 80 years old diagnosed with right-side colon cancer who received RARH or LRH. All data were extracted from the US National Inpatient Sample (NIS) database 2005–2018. Associations between type of surgery and in-hospital outcomes were determined using univariate and multivariable logistic regression and linear regression analysis. Results Data of 7,550 patients (representing 37,126 hospitalized patients in the U.S.) were analyzed. Mean age of the study population was 84.8 years, 61.4% were females, and 79.1% were non-smokers. After adjusting for relevant confounders, regression analysis showed that patients undergoing RARH had a significantly shorter LOS (adjusted Beta (aBeta), -0.24, 95% CI: -0.32, -0.15) but greater total hospital costs (aBeta, 26.54, 95% CI: 24.64, 28.44) than patients undergoing LRH. No significant differences in mortality, perioperative complications, and risk of unfavorable discharge were observed between the two procedures ( p  > 0.05). Stratified analyses by frailty status revealed consistent results. Conclusions RARH is associated with a significantly shorter LOS but higher total hospital costs than LRH among octogenarians and nonagenarians. Other short-term outcomes for this population are similar between the two procedures, including in-hospital mortality, perioperative complications, and unfavorable discharge. These findings also apply to frail patients.