Robotic versus laparoscopic surgery for colorectal cancer in older patients: a systematic review and meta-analysis

Figures & data

Figure 1. Study flow chart.

Table 1. Details of included studies.

Study	Location	Definition of elderly	Groups	Sample size	Median age (years)	Males (%)	ASA III-IV	DM (%)	HTN (%)	ST (%)	Mean tumor size (cm)	Poorly differentiated (%)	T3-T4 stage	TNM stage III–IV	Perineural invasion (%)	Adjuvant chemotherapy (%)	NOS score
Xue 2023 [18]	China	>80 years	RCS LCS	55 56	82 82	56.4 66.1	29 26	21.8 10.7	54.5 48.2	7.3 8.9	4.9 4.5	16.4 23.2	45 47	22 32	5.5 12.5	NR	6
Thompson 2023 [20]	USA	>80 years	RCS LCS	75 104	83.6 83.2	47 43	71 98	19 24	73 78	11 7	NR	20 23	NR	20 26	26 22	8.5 10	6
Pacheco 2023* [21]	USA	>80 years	RCS LCS	3116 9343	84 84	42.2 42.4	NR	NR	NR	NR	NR	NR	NR	954 2894	NR	NR	8
Srinath 2022 [19]	Australia	>80 years	RCS LCS	49 29	85 84	32.6 31	25 22	10.2 24.1	NR	NR	NR	NR	NR	NR	NR	NR	6
Palomba 2022 [22]	Italy	>65 years	RCS LCS	79 116	NR	24 25.7	32 51	NR	NR	NR	NR	NR	NR	NR	NR	NR	6
Richards 2019 [24]	USA	>70 years	RCS LCS	195 666	NR	54 59	NR	NR	NR	NR	NR	NR	NR	NR	NR	NR	6
de’Angelis 2018* [23]	France	>70 years	RCS LCS	58 102	77.8 77	55.2 51.9	27 64	32.8 24.5	NR	NR	29.1 37.7	12.1 7.8	NR	13 26	5.2 9.8	24.1 33.3	8

ASA: American Society of Anesthesiologists; DM: diabetes mellitus; HTN: hypertension; ST: synchronous tumor; RCS: robotic colorectal surgery; LCR: laparoscopic colorectal surgery; TNM: tumor, lymph node, metastasis; NR: not reported; NOS: Newcastle Ottawa scale.

*Propensity score matched study.

Figure 2. Meta-analysis of operation time between robotic and laparoscopic colorectal surgery in older patients.

Figure 3. Meta-analysis of Clavien–Dindo complication rates, conversion to open surgery, reoperation, readmission, and mortality rates between robotic and laparoscopic colorectal surgery in older patients.

Figure 4. Meta-analysis of the length of hospital stay between robotic and laparoscopic colorectal surgery in older patients.

Table 2. Outcomes reported by included studies.

Study	Groups	Sample size	Operative time (mins)	Conversion to open surgery	Time to flatus	Anastomosis leakage	Calvien Dindo complications grades I and II	Calvien Dindo complications grades III and IV	Reoperation	LOS	Mortality	Readmission
Xue 2023 [18]	RCS LCS	55 56	174.4 ± 52.3 170.2 ± 58.8	1 0	2[2-4]* 3[2-4]	1 1	7 10	1 0	NR	10[8-12]* 9[8-11]	0 0	1 1
Thompson 2023 [20]	RCS LCS	75 104	NR	NR	NR	NR	25 36	4 7	3 4	5[2-25]* 6[3-22]	NR	4 8
Pacheco 2023* [21]	RCS LCS	3116 9343	NR	NR	NR	NR	NR	NR	NR	5.9 ± 6 6.4 ± 5.1	130 477	208 684
Srinath 2022 [19]	RCS LCS	49 29	NR	NR	NR	NR	3 4	12 10	NR	NR	NR	NR
Palomba 2022 [22]	RCS LCS	79 116	232.29 ± 54 266.78 ± 60	1 7	NR	NR	7 13	1 2	1 2	NR	NR	NR
Richards 2019 [24]	RCS LCS	195 666	NR	NR	NR	NR	NR	NR	NR	4.3[3–7]* 5.8[4–8]	NR	NR
de’Angelis 2018* [23]	RCS LCS	58 102	300.58 ± 142.5 214.54 ± 42.73	0 0	2.23 ± 1.16 2.03 ± 1.26	4 5	26 14	1 5	0 4	11.67 ± 8.17 14.78 ± 9.36	0 1	1 1

NR: not reported; LOS: length of hospital stay; RCS: robotic colorectal surgery; LCR: laparoscopic colorectal surgery.

*Median [interquartile range].

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