A study on the safety of robotic surgery for older rectal cancer patients from a nutritional perspective

Robotic surgery has been increasingly applied to older patients. However, evidence regarding its safety in older rectal cancer patients, particularly from a nutritional perspective, remains limited. We analyzed the safety of robotic surgery on older rectal cancer patients in terms of nutrition and surgical invasiveness compared to non-older patients. Patients who underwent robotic rectal cancer surgery were retrospectively analyzed and divided into two groups: non-older and older (≥75 years). Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), the controlling nutritional status score (CONUT), and modified Glasgow Prognostic Score (mGPS) were evaluated as nutritional status. Ability and Surgical Stress (E-PASS) were calculated as surgical invasiveness and short-term surgical outcomes were evaluated. A total of 62 patients underwent robotic rectal surgery. In older patients, nutrition status was significantly poor from ALB, PNI, CONUT >5, and mGPS. The E-PASS system showed a high risk of postoperative complications in older with statistical significance. The incidence of major postoperative complications did not differ significantly between older and non-older patients (23.1% vs. 12.2%). Multivariable analysis identified increasing age, intraoperative blood loss, and higher E-PASS surgical stress score as independent predictors of postoperative complications. Three-year overall survival and disease-free survival rates were comparable between groups, and age ≥75 years was not independently associated with overall survival. Despite poorer nutritional status and higher theoretical surgical risk, robotic rectal surgery appears feasible and safe in older patients, with acceptable short-term surgical and oncological outcomes. • Robotic rectal surgery appears safe for elderly patients despite their poorer baseline nutritional status. • Elderly patients showed significantly worse nutritional indicators (PNI, CONUT, mGPS) but did not experience higher postoperative complication rates. • Surgical invasiveness assessed by E-PASS indicated higher theoretical risk in elderly patients, yet actual outcomes were comparable to younger patients. • Short-term oncological results, including overall and disease-free survival, were similar between elderly and non-elderly groups. • Robotic-assisted rectal surgery offers a viable and safe option for elderly rectal cancer patients from both nutritional and surgical perspectives.