RERAS - Robotic Colorectal Resections and ERAS® in Older Adults: Optimizing Recovery or Adding Complexity?

Mohammed El-Ahmar^1,2*Julia Hardt¹Christoph Reissfelder¹Jörg-Peter Ritz²Franziska Peters²Steffen Seyfried¹

• ¹Department of Surgery, Universitatsklinikum Mannheim, Mannheim, Germany
• ²Department of general and visceral surgery, HELIOS Kliniken Schwerin, Schwerin, Germany

Purpose: Robot-assisted surgery (RAS) has established itself as a minimally invasive approach in colorectal surgery, although evidence on its integration with Enhanced Recovery After Surgery (ERAS®) protocols in older patients remains limited. This study aims to describe short-term outcomes of RAS combined with a perioperative treatment according to the ERAS® protocols in patients ≥70 years. Methods: This retrospective analysis of a prospectively maintained database includes all patients aged ≥70 years who underwent robotic colorectal resections at two German colorectal cancer centers between January 2019 and April 2024, managed perioperatively according to the ERAS® protocols. Primary endpoints were the patients' short-term perioperative outcomes, including duration of surgery, conversion rate, postoperative Intermediate-Care-Unit (IMC) admission, postoperative complications according to Clavien-Dindo, anastomotic leak and reoperation rate, length of hospital stay, and compliance to ERAS® guidelines. Results are presented descriptively without a comparator arm. Results: A total of 161 patients (99 colon resections and 62 rectal resections) were included over the study period. Median duration of surgery was 153 (IQR: 130-197) minutes for colon and 243 (IQR: 120-467) minutes for rectal resections. Conversion rates were 1% and 4.8% respectively. Postoperative IMC admission was required in 9.1% (9 Patients) after colon and 12.9% (8 Patients) after rectal-resections, based on individual clinical assesement. Anastomotic leaks occurred in 7 cases (7%) following colon resections, with a total reoperation rate of 10%. Among rectal resections, the anastomotic leakage rate was 9.7% (6 cases) with a total reoperation rate of 16.1%. ERAS® compliance was 91.3% for colon-and 85% for rectal resections. Within the rectal cohort, postoperative complications were associated with a substantially lower perioperative ERAS® compliance compared to patients without complications (73.3% vs. 90.7%). Hospital stay was 5 days (IQR: 4-6 days) for colon-and 6 days (IQR: 5-11 days) for rectal resections. The 30-day readmission rate was 4% (4 cases) for colon and 8% (5 cases) for rectal resections. Conclusion: The integration of RAS colorectal surgery within ERAS® protocols appears feasible and is associated with acceptable short-term outcomes in elderly and comorbid patients. Nonetheless, these results should be interpreted as descriptive observations rather than inferential evidence.