Robotic versus laparoscopic surgery in older colorectal cancer patients: a comparison of clinical outcomes and inflammatory markers

BACKGROUND: Previous studies have indicated that robotic surgery offers similar safety and efficacy to laparoscopic surgery in older colorectal cancer patients, while its potential advantages remain to be clarified. METHODS: This retrospective study analyzed older colorectal cancer patients undergoing robotic or laparoscopic surgery at Beijing Hospital. Propensity score matching (PSM) and inverse probability weighting (IPTW) to overcome selection bias. Primary outcomes focused on perioperative inflammatory markers (PNI, NLR, LMR, PLR, SII), while secondary endpoints included surgical, pathological, and clinical outcomes. The study evaluated robotic surgery's safety, efficacy, and potential advantages, offering insights into its clinical application for older patients. RESULTS: A total of 804 patients were initially enrolled in this study, and after screening, 539 cases were included in the final analysis. In the comparison of perioperative inflammatory marker changes, the robotic surgery group consistently demonstrated a lower inflammatory response. Additionally, the robotic surgery group had significantly lower postoperative drainage volumes at both 48 h (148 mL vs. 200 mL, p < 0.05) and 72 h (228 mL vs. 290 mL, p < 0.05). There were no significant differences between the two groups in terms of postoperative complications or length of hospital stay. During a median follow-up of 21.1 months, there were no significant differences in overall survival (OS) or disease-free survival (DFS) between the two groups. CONCLUSION: Robotic surgery for older patients with colorectal cancer demonstrates comparable safety and efficacy to laparoscopic surgery, while offering significantly improved control of perioperative inflammatory responses.