Robotic-Assisted Colorectal Procedures in the Elderly.

Rami Makhoul, MD, Sam Luka, MD, Samir Agarwal, MD, Ashley Tirona, Vincent J Obias, MD

George Washington University

BACKGROUND:
The robotic system is being adopted as a minimally invasive modality for colorectal resections in many institutions. The advantages, including stable platform, dexterity and better visualization have been well established in the literature. However, data on the outcome and survival of elderly patients who underwent robotic colon and rectal resections are limited. Our aim was to examine the complication rate following robotic-assisted colorectal surgeries in the elderly population.

METHODS:
We conducted a retrospective review of 144 consecutive colon and rectal procedures by a single surgeon using the da Vinci robotic system at our institution between October 2009 and July 2012. We defined elderly patients as being 65 years or older based on the WHO criteria. 51 patients were 65 years or older. Intraoperative and postoperative complications were the primary endpoint. Perioperative data such operative time and length of hospital stay were also examined.

RESULTS:
Fifty-one procedures were performed: including abdominoperineal resection, low anterior resection, rectopexy and right/left/sigmoid/total colectomy. The mean age at surgery was 73.4 years, and mean BMI at surgery was 26.6 kg/m². Preoperative indications included polyps, diverticular disease, ulcerative colitis, and cancer. The mean operative time was 247.5 (120-630) min; the median length of stay was 4 (1-30) days. Of the 51 patients, 7 had intraoperative or postoperative complications, for a rate of 13.7%. These included stroke, myocardial infarction, intra-abdominal abscess, incisional hernia and wound infection. Two procedures were converted to open, for an overall conversion rate of 3.9%.

CONCLUSION:
Our experience and short-term outcomes demonstrates that robotic colon and rectal surgery in the elderly population is safe and feasible. The operative time and length of hospital stay were not significantly longer than those described in the literature. Long-term outcomes are still needed to validate our results.

Session: Poster Presentation

Program Number: P185