Robotic-Assisted Compared to Laparoscopic Resection of Rectal Cancer in Patients Aged ≥65 Years: A Propensity Score–Matched Analysis of the NCDB

Background: Older adults constitute a large proportion of patients with rectal cancer, yet rectal-specific comparative data on minimally invasive approaches remain limited. This study compared outcomes of laparoscopic versus robotic rectal resection in patients aged ≥65 years. Methods: We performed a retrospective analysis of patients with stage I–III rectal adenocarcinoma from the U.S. National Cancer Database (NCDB) from 2010 to 2021. Patients undergoing laparoscopic or robotic-assisted surgery were identified and propensity-score matched for clinically relevant covariates. The primary outcome was conversion to open surgery. Secondary outcomes included short-term mortality, readmission, hospital stay, pathological outcomes, and 5-year overall survival (OS). Results: Among 18,877 eligible patients, 4099 patients were matched in each group. Robotic surgery was more frequently performed for patients with stage III tumors (45.0% versus 36.9%), elevated carcinoembryonic antigen levels (60.2% versus 48.1%), and those who underwent abdominoperineal resection (25.2% versus 18.9%). After matching, robotic surgery was associated with a significantly lower conversion rate compared with laparoscopy (6.2% versus 14.9%; OR 0.38, 95% CI 0.33–0.44; P < .001). No significant differences were observed in 30-day mortality (1.2% versus 1.5%), 90-day mortality (2.5% versus 2.7%), unplanned 30-day readmission (7.3% versus 7.6%), or 5-year OS (70.5% versus 69.0%; P = .062). Median hospital stay was 5 days for both groups. Suboptimal lymph node yield (