Graziano Ceccarelli1, Enrico Andolfi1, Alessia Biancafarina1, Aldo Rocca2,3, Maurizio Amato4, Marco Milone4, Marta Scricciolo1, Barbara Frezza1, Egidio Miranda1, Marco De Prizio1, Andrea Fontani1. 1. Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy. 2. Department of Surgery, Division of General Surgery, Hospital of Arezzo, Arezzo, Italy. aldorocca@hotmail.it. 3. Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via Sergio Pansini, 80131, Naples, Italy. aldorocca@hotmail.it. 4. Department of Surgical Specialities and Nephrology, University of Naples "Federico II", Naples, Italy.
Abstract
BACKGROUND: Although there is no agreement on a definition of elderly, commonly an age cutoff of ≥65 or 75 years is used. Nowadays most of malignancies requiring surgical treatment are diagnosed in old population. Comorbidities and frailty represent well-known problems during and after surgery in elderly patients. Minimally invasive surgery offers earlier postoperative mobilization, less blood loss, lower morbidity as well as reduction in hospital stay and as such represents an interesting and validated option for elderly population. Robot-assisted surgery is a recent improvement of conventional minimally invasive surgery. AIMS: We provided a complete review of old and very old patients undergoing robot-assisted surgery for oncologic and general surgery interventions. PATIENTS AND METHODS: A retrospective review of all patients undergoing robot-assisted surgery in our General Surgery Unit from September 2012 to June 2016 was conducted. Analysis was performed for the entire cohort and in particular for three of the most performed surgeries (gastric resections, right colectomy, and liver resections) classifying patients into three age groups: ≤64, 65-79, and ≥80. Data from these three different age groups were compared and examined in respect of different outcomes: ASA score, comorbidities, oncologic outcomes, conversion rate, estimated blood loss, hospital stay, geriatric events, mortality, etc. RESULTS: Using our in-patient robotic surgery database, we retrospectively examined 363 patients, who underwent robot-assisted surgery for different diseases (402 different robotic procedures): colorectal surgery, upper GI, HPB, etc.; the oncologic procedures were 81%. Male were 56%. The mean age was 65.63 years (18-89). Patients aged ≥65 years represented 61% and ≥80 years 13%. Overall conversion rate was of 6%, most in the group 65-79 years (59% of all conversions). The more frequent diseases treated were colorectal surgery 43%, followed by hepatobilopancreatic surgery 23.4%, upper gastro-intestinal 23.2%, and others 10.4%. DISCUSSION: Robot-assisted surgery is a safe and effective technique in aging patient population too. There was no increased risk of death or morbidity compared to younger patients in the three groups examined. A higher conversion rate was observed in our experience for patients aged 65-79. Prolonged operative time and in any cases steep positions (Trendelenburg) have not represented a problem for the majority of patients. CONCLUSIONS: In any case, considering the high direct costs, minimally invasive robot-assisted surgery should be performed on a case-by-case basis, tailored to each patient with their specific histories and comorbidities.
BACKGROUND: Although there is no agreement on a definition of elderly, commonly an age cutoff of ≥65 or 75 years is used. Nowadays most of malignancies requiring surgical treatment are diagnosed in old population. Comorbidities and frailty represent well-known problems during and after surgery in elderly patients. Minimally invasive surgery offers earlier postoperative mobilization, less blood loss, lower morbidity as well as reduction in hospital stay and as such represents an interesting and validated option for elderly population. Robot-assisted surgery is a recent improvement of conventional minimally invasive surgery. AIMS: We provided a complete review of old and very old patients undergoing robot-assisted surgery for oncologic and general surgery interventions. PATIENTS AND METHODS: A retrospective review of all patients undergoing robot-assisted surgery in our General Surgery Unit from September 2012 to June 2016 was conducted. Analysis was performed for the entire cohort and in particular for three of the most performed surgeries (gastric resections, right colectomy, and liver resections) classifying patients into three age groups: ≤64, 65-79, and ≥80. Data from these three different age groups were compared and examined in respect of different outcomes: ASA score, comorbidities, oncologic outcomes, conversion rate, estimated blood loss, hospital stay, geriatric events, mortality, etc. RESULTS: Using our in-patient robotic surgery database, we retrospectively examined 363 patients, who underwent robot-assisted surgery for different diseases (402 different robotic procedures): colorectal surgery, upper GI, HPB, etc.; the oncologic procedures were 81%. Male were 56%. The mean age was 65.63 years (18-89). Patients aged ≥65 years represented 61% and ≥80 years 13%. Overall conversion rate was of 6%, most in the group 65-79 years (59% of all conversions). The more frequent diseases treated were colorectal surgery 43%, followed by hepatobilopancreatic surgery 23.4%, upper gastro-intestinal 23.2%, and others 10.4%. DISCUSSION: Robot-assisted surgery is a safe and effective technique in aging patient population too. There was no increased risk of death or morbidity compared to younger patients in the three groups examined. A higher conversion rate was observed in our experience for patients aged 65-79. Prolonged operative time and in any cases steep positions (Trendelenburg) have not represented a problem for the majority of patients. CONCLUSIONS: In any case, considering the high direct costs, minimally invasive robot-assisted surgery should be performed on a case-by-case basis, tailored to each patient with their specific histories and comorbidities.
Authors: Aldo Rocca; Enrico Andolfi; Anna Ginevra Immacolata Zamboli; Giuseppe Surfaro; Domenico Tafuri; Gianluca Costa; Barbara Frezza; Marta Scricciolo; Maurizio Amato; Paolo Bianco; Sergio Brongo; Graziano Ceccarelli; Antonio Giuliani; Bruno Amato Journal: Open Med (Wars) Date: 2019-05-21
Authors: Gianluca Costa; Barbara Frezza; Pietro Fransvea; Giulia Massa; Mario Ferri; Paolo Mercantini; Genoveffa Balducci; Antonio Buondonno; Aldo Rocca; Graziano Ceccarelli Journal: Open Med (Wars) Date: 2019-10-02
Authors: Antonio Giuliani; Pasquale Avella; Anna Lucia Segreto; Maria Lucia Izzo; Antonio Buondonno; Mariagrazia Coluzzi; Micaela Cappuccio; Maria Chiara Brunese; Roberto Vaschetti; Andrea Scacchi; Germano Guerra; Bruno Amato; Fulvio Calise; Aldo Rocca Journal: Front Surg Date: 2021-12-21
Authors: Hülya Sarikaya; Tahar Benhidjeb; Sergiu I Iosivan; Theodoros Kolokotronis; Christine Förster; Stephan Eckert; Ludwig Wilkens; Alaa Nasser; Sebastian Rehberg; Martin Krüger; Jan Schulte Am Esch Journal: Sci Rep Date: 2020-09-15 Impact factor: 4.379