Journal of Robotic Surgery

, Volume 4, Issue 2, pp 91–98

Safety of robotic general surgery in elderly patients

  • Nicolas C. Buchs
  • Pietro Addeo
  • Francesco M. Bianco
  • Subhashini Ayloo
  • Enrique F. Elli
  • Pier C. Giulianotti
Original Article

Abstract

As the life expectancy of people in Western countries continues to rise, so too does the number of elderly patients. In parallel, robotic surgery continues to gain increasing acceptance, allowing for more complex operations to be performed by minimally invasive approach and extending indications for surgery to this population. The aim of this study is to assess the safety of robotic general surgery in patients 70 years and older. From April 2007 to December 2009, patients 70 years and older, who underwent various robotic procedures at our institution, were stratified into three categories of surgical complexity (low, intermediate, and high). There were 73 patients, including 39 women (53.4%) and 34 men (46.6%). The median age was 75 years (range 70–88 years). There were 7, 24, and 42 patients included, respectively, in the low, intermediate, and high surgical complexity categories. Approximately 50% of patients underwent hepatic and pancreatic resections. There was no statistically significant difference between the three groups in terms of morbidity, mortality, readmission or transfusion. Mean overall operative time was 254 ± 133 min (range 15–560 min). Perioperative mortality and morbidity was 1.4% and 15.1%, respectively. Transfusion rate was 9.6%, and median length of stay was 6 days (range 0–30 days). Robotic surgery can be performed safely in the elderly population with low mortality, acceptable morbidity, and short hospital stay. Age should not be considered as a contraindication to robotic surgery even for advanced procedures.

Keywords

Robotic surgery Elderly Pancreatic surgery Liver resection Outcomes Complications 

References

  1. 1.
    Andereggen E, Ris F, Gervaz P, Bucher P, Morel P (2006) Outcome of surgery for rectal cancer in octogenarians. Swiss Med Wkly 136:185–188PubMedGoogle Scholar
  2. 2.
    Etzioni DA, Liu JH, Maggard MA, Ko CY (2003) The aging population and its impact on the surgery workforce. Ann Surg 238:170–177PubMedGoogle Scholar
  3. 3.
    Janssen-Heijnen ML, Maas HA, Houterman S, Lemmens VE, Rutten HJ, Coebergh JW (2007) Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer 43:2179–2193CrossRefPubMedGoogle Scholar
  4. 4.
    Janssen-Heijnen ML, Houterman S, Lemmens VE, Louwman MW, Maas HA, Coebergh JW (2005) Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit Rev Oncol Hematol 55:231–240CrossRefPubMedGoogle Scholar
  5. 5.
    Spivak H, Maele DV, Friedman I, Nussbaum M (1996) Colorectal surgery in octogenarians. J Am Coll Surg 183:46–50PubMedGoogle Scholar
  6. 6.
    Abir F, Alva S, Longo WE (2004) The management of rectal cancer in the elderly. Surg Oncol 13:223–234CrossRefPubMedGoogle Scholar
  7. 7.
    Hodul P, Tansey J, Golts E, Oh D, Pickleman J, Aranha GV (2001) Age is not a contraindication to pancreaticoduodenectomy. Am Surg 67:270–275PubMedGoogle Scholar
  8. 8.
    Fong Y, Blumgart LH, Fortner JG, Brennan MF (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222:426–434PubMedGoogle Scholar
  9. 9.
    Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, Riall TS, Yeo CJ (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10:347–356CrossRefPubMedGoogle Scholar
  10. 10.
    Scurtu R, Bachellier P, Oussoultzoglou E, Rosso E, Maroni R, Jaeck D (2006) Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg 10:813–822CrossRefPubMedGoogle Scholar
  11. 11.
    Brozzetti S, Mazzoni G, Miccini M, Puma F, De Angelis M, Cassini D, Bettelli E, Tocchi A, Cavallaro A (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141:137–142CrossRefPubMedGoogle Scholar
  12. 12.
    Zacharias T, Jaeck D, Oussoultzoglou E, Bachellier P, Weber JC (2004) First and repeat resection of colorectal liver metastases in elderly patients. Ann Surg 240:858–865CrossRefPubMedGoogle Scholar
  13. 13.
    Ceulemans R, Al-Ahdab N, Leroy J, Garcia A, Dutson E, Rubino F, Simone M, Mutter D, Marescaux J (2004) Safe laparoscopic surgery in the elderly. Am J Surg 187:323–327CrossRefPubMedGoogle Scholar
  14. 14.
    Vignali A, Di Palo S, Tamburini A, Radaelli G, Orsenigo E, Staudacher C (2005) Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum 48:2070–2075CrossRefPubMedGoogle Scholar
  15. 15.
    Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Yamaguchi T (2009) Short-term outcomes of laparoscopic rectal surgery for primary rectal cancer in elderly patients: is it safe and beneficial? J Gastrointest Surg 13:1614–1618CrossRefPubMedGoogle Scholar
  16. 16.
    Chautard J, Alves A, Zalinski S, Bretagnol F, Valleur P, Panis Y (2008) Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg 206:255–260CrossRefPubMedGoogle Scholar
  17. 17.
    Senagore AJ, Madbouly KM, Fazio VW, Duepree HJ, Brady KM, Delaney CP (2003) Advantages of laparoscopic colectomy in older patients. Arch Surg 138:252–256CrossRefPubMedGoogle Scholar
  18. 18.
    Cheung HY, Chung CC, Fung JT, Wong JC, Yau KK, Li MK (2007) Laparoscopic resection for colorectal cancer in octogenarians: results in a decade. Dis Colon Rectum 50:1905–1910CrossRefPubMedGoogle Scholar
  19. 19.
    Hoekstra HJ (2001) Cancer surgery in the elderly. Eur J Cancer 37(Suppl 7):S235–S244CrossRefPubMedGoogle Scholar
  20. 20.
    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784CrossRefPubMedGoogle Scholar
  21. 21.
    Lee DJ, Rothberg MB, McKiernan JM, Benson MC, Badani KK (2009) Robot-assisted radical cystoprostatectomy in complex surgical patients: single institution report. Can J Urol 16:4664–4669PubMedGoogle Scholar
  22. 22.
    Woods M, Thomas R, Davis R, Andrews PE, Ferrigni RG, Cheng J, Castle EP (2008) Robot-assisted extended pelvic lymphadenectomy. J Endourol 22:1297–1302CrossRefPubMedGoogle Scholar
  23. 23.
    Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 110:1951–1958CrossRefPubMedGoogle Scholar
  24. 24.
    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2, 804 patients. Ann Surg 250:831–841CrossRefPubMedGoogle Scholar
  25. 25.
    Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Lapalorcia LM, Casciola L (2009) Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg 16:450–457CrossRefPubMedGoogle Scholar
  26. 26.
    Riall TS, Reddy DM, Nealon WH, Goodwin JS (2008) The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 248:459–467PubMedGoogle Scholar
  27. 27.
    Riall TS (2009) What is the effect of age on pancreatic resection? Adv Surg 43:233–249CrossRefPubMedGoogle Scholar
  28. 28.
    Fathy O, Wahab MA, Elghwalby N, Sultan A, EL-E G, Hak NG, Abu Zeid M, Abd-Allah T, El-Shobary M, Fouad A et al (2008) 216 cases of pancreaticoduodenectomy: risk factors for postoperative complications. Hepatogastroenterology 55:1093–1098PubMedGoogle Scholar
  29. 29.
    Gagner M, Palermo M (2009) Laparoscopic Whipple procedure: review of the literature. J Hepatobiliary Pancreat Surg 16:726–730CrossRefPubMedGoogle Scholar
  30. 30.
    Iversen LH, Pedersen L, Riis A, Friis S, Laurberg S, Sorensen HT (2005) Age and colorectal cancer with focus on the elderly: trends in relative survival and initial treatment from a Danish population-based study. Dis Colon Rectum 48:1755–1763CrossRefPubMedGoogle Scholar
  31. 31.
    Ostermann S, Bucher P, Gervaz P, Morel P (2009) Really so far from fast-track colorectal surgery in senior patients? Rev Med Suisse 5:1676–1679PubMedGoogle Scholar
  32. 32.
    Iversen LH, Bulow S, Christensen IJ, Laurberg S, Harling H (2008) Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer. Br J Surg 95:1012–1019CrossRefPubMedGoogle Scholar
  33. 33.
    Skala K, Gervaz P, Buchs N, Inan I, Secic M, Mugnier-Konrad B, Morel P (2009) Risk factors for mortality-morbidity after emergency-urgent colorectal surgery. Int J Colorectal Dis 24:311–316CrossRefPubMedGoogle Scholar
  34. 34.
    Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ (2009) Robotic colorectal surgery: hype or new hope? A systematic review of robotics in colorectal surgery. Colorectal Dis Jul 6Google Scholar
  35. 35.
    Bardram L, Funch-Jensen P, Kehlet H (2000) Rapid rehabilitation in elderly patients after laparoscopic colonic resection. Br J Surg 87:1540–1545CrossRefPubMedGoogle Scholar
  36. 36.
    Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH (2001) ‘Fast track’ postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 88:1533–1538CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd 2010

Authors and Affiliations

  • Nicolas C. Buchs
    • 1
  • Pietro Addeo
    • 1
  • Francesco M. Bianco
    • 1
  • Subhashini Ayloo
    • 1
  • Enrique F. Elli
    • 1
  • Pier C. Giulianotti
    • 1
    • 2
  1. 1.Division of General, Minimally Invasive and Robotic Surgery, Department of SurgeryUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Lloyd M. Nyhus Professor of Surgery, Chief Division of General, Minimally Invasive and Robotic SurgeryUniversity of Illinois at ChicagoChicagoUSA

Personalised recommendations