- Design
- Systematic review and meta-analysis of observational studies
- Population
- 41 comparative studies of older adults having robotic or laparoscopic surgery
- Primary outcome
- Recovery-centred outcomes, conversion and morbidity
- Effect
- Colorectal conversion OR 0.36 (0.18–0.72); colorectal morbidity OR 0.67 (0.43–1.05)
This systematic review, published in the Journal of Robotic Surgery on 26 September, looked for studies comparing robotic and laparoscopic surgery in older adults with outcomes that matter for recovery. It found 41 observational studies and no randomised trials.
In four colorectal cohorts, robotic surgery was associated with fewer conversions to open surgery (OR 0.36). Overall colorectal complications were not clearly different (OR 0.67, interval crossing 1), and estimates for severe complications and gastric surgery were imprecise. Frailty and functional recovery were rarely measured.
For geriatricians advising older patients before surgery, the robot is not a reason in itself to expect better recovery. Frailty assessment, prehabilitation and good perioperative care remain the factors with the clearest influence.
- Do not assume a robotic operation will mean easier recovery for an older patient.
- Assess frailty before major surgery, whatever the approach.
- Consider prehabilitation for frail older adults awaiting surgery.
- Ask surgical teams to record functional recovery, not only complications.
Why it matters
The outcomes older patients care about most, function and independence, were rarely measured.
Don't overread it
All included studies were observational, with overlapping cohorts and residual confounding.
The statistics, in plain English
An odds ratio of 0.36 means about a third of the odds of conversion, but it comes from four observational cohorts. For complications, the interval (0.43 to 1.05) includes no difference.
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