Influence of robotics in surgical complication rate in elderly population with rectal cancer

  • Irene Ramallo-Solis
  • Rosa M. Jimenez-RodriguezEmail author
  • M. Luisa Reyes-Diaz
  • José Manuel Diaz-Pavon
  • Jorge Manuel Vazquez-Monchul
  • Ana M. Garcia-Cabrera
  • Javier Padillo
  • Fernando de la Portilla
Original Article



Rectal cancer surgery is a technically complex procedure. Moreover, short-term outcomes show high rate of complications especially in elderly and laparoscopic surgery has not demonstrated to be able to reduce this complication rate. Robotics has several advantages in pelvic surgical procedures, which could have an impact in complication rates in elderly patients.


The aim of our study is to demonstrate whether robotic surgery has any influence on the reduction of complications in the aged population undergoing rectal cancer.


We performed a retrospective analysis of a prospective database of 151 patients who underwent robotic surgery for rectal cancer. We divided our population into three groups: under 65-year-old, between 65- and 80-year-old and above 80-year-old. We recorded complications in each group intra and post procedure.


The present study included 151 patients (94 males). Of them, 77 patients were under 66 year old, 63 patients were between 66 and 79 year old and 11 patients were 80 year old and above. The analysis showed conversion rates of 10.38%, 13.69%, 27.27%, and the complication rate of 23.4%, 23.8%, and 27.3% in each group. Univariate analysis showed no differences between the three groups. Nevertheless, there were statistical differences from BMI, ASA and neoadjuvant therapy. In multivariant analysis only neoadjuvant therapy was significant.


Robotic approach does not decrease complications in elderly population and conversion is similar in these age groups. So we should not rule out robotic surgery in elderly patients, although we must select each case with a multidisciplinary approach.


Rectal cancer Rectal surgery Robotics Elderly Complications 


Author contributions

All authors were responsible for conceptualizing and designing the study; collecting, analyzing and interpreting the data and drafting the manuscript. All authors gave their approval on the final version for publication.


No sources or funding.

Compliance with ethical standards

Conflict of interest

Authors have no disclosures or conflict of interest.

Statement of human and animal rights

Our work does not contain any studies with animals performed by any of the authors.

Informed consent

All patients gave their informed consent to take part on the study which was approved by the ethics committee of the Hospital Universitario Virgen del Rocio, Sevilla.


  1. 1.
    Atallah C, Efron JE (2017) Laparoscopy for rectal cancer. Clin Colon Rectal Surg 30:104–111. CrossRefGoogle Scholar
  2. 2.
    Ishibe A, Ota M, Fujii S et al (2017) Midterm follow-up of a randomized trial of open surgery versus laparoscopic surgery in elderly patients with colorectal cancer. Surg Endosc. Google Scholar
  3. 3.
    Manceau G, Hain E, Maqqiori L, Monquin C, Prost A, la Denise J, Paris Y (2017) Is the benefit of laparoscopy maintained in elderly patients undergoing rectal cancer resection? An analysis of 44 consecutive patients. Surg Endosc 31:632–642CrossRefGoogle Scholar
  4. 4.
    Valverde A, Goasguen N, Oberlin O (2017) Robotic versus laparoscopic rectal resection for sphincter-saving surgery: pathological and short-term outcomes in a single-center analysis of 130 consecutive patients. Surg Endosc. Google Scholar
  5. 5.
    Morelli L, Guadagni S, Lorenzoni V, Di Franco G, Cobuccio L, Palmeri M, Caprili G, D’Isidoro C, Moglia A, Ferrari V, Di Candio G, Mosca F, Turchetti G (2016) Robot-assisted versus laparoscopic rectal resection for cancer in a single surgeon’s experience: a cost analysis covering the initial 50 robotic cases with the Da Vinci S. Int J Colorectal Dis 31:1639–1648CrossRefGoogle Scholar
  6. 6.
    Kim JC, Yu CS, Lim SB, Park IJ, Kim CW, Yoon YS (2016) Comparative analysis focusing on surgical and early oncological outcomes of open, laparoscopy-assisted and robot-assisted approaches in rectal cancer patients. Int J Colorectal Dis 31:1179–1187CrossRefGoogle Scholar
  7. 7.
    Sujatha-Bhaskar S, Jafari MD, Gahagan JV, Inaba CS, Koh CY, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2017) Defining the role of minimally invasive proctectomy for locally advanced rectal adenocarcinoma. Ann Surg 266:574–581CrossRefGoogle Scholar
  8. 8.
    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefGoogle Scholar
  9. 9.
    American Cancer Society Key statistics for colorectal cancer. Accessed 14 Mar 2017
  10. 10.
    Oldani A, Bellora P, Monni M, Amato B, Gentilli S (2017) Colorectal surgery in elderly patients: our experience with Da Vinci Xi. Aging Clin Exp Res 29:91–99CrossRefGoogle Scholar
  11. 11.
    Ceccarelli G, Andolfi E, Biancafarina A, Rocca A, Amato M, Milone M, Scricciolo M, Miranda E, De Prizio M, Fontani A (2017) Robot-assisted surgery in elderly and very elderly population: our experience in oncologic and general surgery with literature review. Aging Clin Exp Res 29:55–63CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Irene Ramallo-Solis
    • 1
  • Rosa M. Jimenez-Rodriguez
    • 1
    • 6
    Email author
  • M. Luisa Reyes-Diaz
    • 1
  • José Manuel Diaz-Pavon
    • 1
  • Jorge Manuel Vazquez-Monchul
    • 2
  • Ana M. Garcia-Cabrera
    • 1
  • Javier Padillo
    • 3
    • 5
  • Fernando de la Portilla
    • 4
    • 5
  1. 1.Department of General and Digestive Surgery, Colorectal Surgery Unit“Virgen del Rocío” University HospitalSevilleSpain
  2. 2.Department of General and Digestive Surgery, Colorrectal Surgery Unit“Virgen del Rocío”SevilleSpain
  3. 3.Department of General and Digestive Surgery“Virgen del Rocío” University Hospital/IBiS/CSIC/University of SevilleSevilleSpain
  4. 4.Department of General and Digestive Surgery, Colorectal Surgery Unit“Virgen del Rocío” University Hospital/IBiS/CSIC/University of SevilleSevilleSpain
  5. 5.Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD o Ciberehd)Instituto de Salud Carlos IIIMadridSpain
  6. 6.Colorectal Unit, Department of SurgeryHospital Universitario Virgen del RocíoSevilleSpain

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