{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T15:20:36Z","timestamp":1790436036085,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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\u00ae) 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\u00ae protocols in patients \u226570 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective analysis of a prospectively maintained database includes all patients aged \u226570 years who underwent robotic colorectal resections at two German colorectal cancer centers between January 2019 and April 2024, managed perioperatively according to the ERAS\u00ae 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\u00ae guidelines. Results are presented descriptively without a comparator arm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2013197) minutes for colon and 243 (IQR: 120\u2013467) 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\u00ae 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\u00ae compliance compared to patients without complications (73.3% vs. 90.7%). Hospital stay was 5 days (IQR: 4\u20136 days) for colon- and 6 days (IQR: 5\u201311 days) for rectal resections. The 30-day readmission rate was 4% (4 cases) for colon and 8% (5 cases) for rectal resections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The integration of RAS colorectal surgery within ERAS\u00ae 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2025.1638414","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T06:40:02Z","timestamp":1764744002000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["RERAS\u2014robotic colorectal resections and ERAS\u00ae in older adults: optimizing recovery or adding complexity?"],"prefix":"10.3389","volume":"12","author":[{"given":"M.","family":"El-Ahmar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Reissfelder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.-P.","family":"Ritz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Peters","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Seyfried","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1324","DOI":"10.1056\/NEJMoa1414882","article-title":"A randomized trial of laparoscopic versus open surgery for rectal cancer","volume":"372","author":"Bonjer","year":"2015","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/s00104-021-01567-7","article-title":"First 18 months as certified ERAS\u00ae center for colorectal cancer: lessons learned and results of the first 261 patients","volume":"93","author":"Koch","year":"2022","journal-title":"Chirurgie (Heidelb)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1093\/bja\/78.5.606","article-title":"Multimodal approach to control postoperative pathophysiology and rehabilitation","volume":"78","author":"Kehlet","year":"1997","journal-title":"Br J Anaesth"},{"key":"B4","volume-title":"S3-Leitlinie Perioperatives Management bei gastrointestinalen Tumoren (POMGAT)","year":"2023"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1007\/s00384-018-3163-y","article-title":"Frailty in surgical patients","volume":"33","author":"Richards","year":"2018","journal-title":"Int J Colorectal Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1080\/13645706.2024.2359705","article-title":"Robotic versus laparoscopic surgery for colorectal cancer in older patients: a systematic review and meta-analysis","volume":"34","author":"Wang","year":"2024","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"5686","DOI":"10.1007\/s00464-020-08026-0","article-title":"Long-term results of a randomized study comparing open surgery and laparoscopic surgery in elderly colorectal cancer patients (Eld Lap study)","volume":"35","author":"Fujii","year":"2021","journal-title":"Surg Endosc"},{"key":"B8","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/j.anclin.2023.02.010","article-title":"Enhanced recovery after surgery and elderly patients: advances","volume":"41","author":"Ljungqvist","year":"2023","journal-title":"Anesthesiol Clin"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e32942","DOI":"10.1097\/MD.0000000000032942","article-title":"The enhanced recovery after surgery (ERAS) protocol in elderly patients with acute cholecystitis: a retrospective study","volume":"102","author":"Yu","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00268-018-4844-y","article-title":"Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS(\u00ae)) society recommendations: 2018","volume":"43","author":"Gustafsson","year":"2019","journal-title":"World J Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s11701-022-01414-9","article-title":"Comparison of robotic vs laparoscopic left-sided colorectal cancer resections","volume":"17","author":"Hettiarachchi","year":"2023","journal-title":"J Robot Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1007\/s00384-023-04380-2","article-title":"Robotic colorectal resection in combination with a multimodal enhanced recovery program\u2014results of the first 100 cases","volume":"38","author":"El-Ahmar","year":"2023","journal-title":"Int J Colorectal Dis"},{"key":"B13","volume-title":"S3-Leitlinie Kolorektales Karzinom","year":"2019"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.7150\/jca.65817","article-title":"Impact of operation duration on short-term and long-term prognosis in patients undergoing radical colorectal surgery","volume":"13","author":"Shen","year":"2022","journal-title":"J Cancer"},{"key":"B15","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1111\/codi.15398","article-title":"The robotic colorectal experience: an outcomes and learning curve analysis of 502 patients","volume":"23","author":"Parascandola","year":"2021","journal-title":"Colorectal Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2215","DOI":"10.1007\/s11605-022-05343-8","article-title":"Learning curve of robotic right hemicolectomy","volume":"26","author":"Tang","year":"2022","journal-title":"J Gastrointest Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1187476","DOI":"10.3389\/fonc.2023.1187476","article-title":"Robotic versus laparoscopic right hemicolectomy with complete mesocolic excision: a retrospective multicenter study with propensity score matching","volume":"13","author":"Tian","year":"2023","journal-title":"Front Oncol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"3483","DOI":"10.21873\/invivo.12649","article-title":"Impact of intraoperative blood loss on the survival of patients with stage II\/III colorectal cancer: a multicenter retrospective study","volume":"35","author":"Tamagawa","year":"2021","journal-title":"In Vivo"},{"key":"B19","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1177\/0036933015597174","article-title":"Is estimated intra-operative blood loss a reliable predictor of surgical outcomes in laparoscopic colorectal cancer surgery?","volume":"61","author":"Saleh","year":"2016","journal-title":"Scott Med J"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2455","DOI":"10.1001\/jama.290.18.2455","article-title":"Efficacy of postoperative epidural analgesia: a meta-analysis","volume":"290","author":"Block","year":"2003","journal-title":"Jama"},{"key":"B21","volume-title":"StuDoQ Qualit\u00e4tsreport Kolorektales Karzinom 2021","year":"2021"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1007\/s00384-022-04242-3","article-title":"Laparoscopic rectal resection without epidural catheters-does it work?","volume":"37","author":"El-Ahmar","year":"2022","journal-title":"Int J Colorectal Dis"},{"key":"B23","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1097\/EJA.0b013e32835b162c","article-title":"Epidural analgesia and postoperative orthostatic haemodynamic changes: observational study","volume":"30","author":"Gramigni","year":"2013","journal-title":"Eur J Anaesthesiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"3244","DOI":"10.12659\/MSM.906973","article-title":"Effects of laparoscopic and conventional methods on lung functions in colorectal surgery","volume":"24","author":"Celik","year":"2018","journal-title":"Med Sci Monit"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1628","DOI":"10.1097\/DCR.0000000000001799","article-title":"Assessment of the risk and economic burden of surgical site infection following colorectal surgery using a US longitudinal database: is there a role for innovative antimicrobial wound closure technology to reduce the risk of infection?","volume":"63","author":"Leaper","year":"2020","journal-title":"Diseases of the Colon & Rectum"},{"key":"B26","doi-asserted-by":"publisher","first-page":"47","DOI":"10.5114\/pg.2021.106083","article-title":"Postoperative sepsis after colorectal surgery: a prospective single-center observational study and review of the literature","volume":"17","author":"Mulita","year":"2022","journal-title":"Prz Gastroenterol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"3289","DOI":"10.1245\/s10434-017-5881-8","article-title":"Oncologic impact of anastomotic leakage following colorectal cancer surgery: a systematic review and meta-analysis","volume":"24","author":"Ha","year":"2017","journal-title":"Ann Surg Oncol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1016\/j.suronc.2018.10.003","article-title":"Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer","volume":"27","author":"Ramphal","year":"2018","journal-title":"Surg Oncol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1097\/01.sla.0000133186.81222.08","article-title":"Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer","volume":"240","author":"Walker","year":"2004","journal-title":"Ann Surg"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1007\/s00268-014-2887-2","article-title":"The impact of anastomotic leak and its treatment on cancer recurrence and survival following elective colorectal cancer resection","volume":"39","author":"Nachiappan","year":"2015","journal-title":"World J Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"4375","DOI":"10.3390\/jcm11154375","article-title":"Anastomotic leak impact on long-term survival after right colectomy for cancer: a propensity-score-matched analysis","volume":"11","author":"Dulskas","year":"2022","journal-title":"J Clin Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/s12957-020-01968-8","article-title":"Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery","volume":"18","author":"Kryzauskas","year":"2020","journal-title":"World J Surg Oncol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1007\/s00423-023-02986-2","article-title":"Reconstruction, oversewing, or taking the anastomosis down\u2014which surgical intervention is most potent in the treatment of anastomotic leaks following colorectal resections?","volume":"408","author":"El-Ahmar","year":"2023","journal-title":"Langenbecks Arch Surg"},{"key":"B34","year":"2021","journal-title":"Jahresbericht Darm 2021 (Auditjahr 2020 \/ Kennzahlenjahr 2019) \u2013 Qualit\u00e4tsindikatoren Darmkrebs 2021"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1502","DOI":"10.1007\/s11605-019-04170-8","article-title":"Is the enhanced recovery after surgery (ERAS) program effective and safe in laparoscopic colorectal cancer surgery? A meta-analysis of randomized controlled trials","volume":"23","author":"Ni","year":"2019","journal-title":"J Gastrointest Surg"},{"key":"B36","first-page":"2909","article-title":"Monitoring an ongoing enhanced recovery after surgery (ERAS) program: adherence improves clinical outcomes in a comparison of three thousand colorectal cases","volume":"5","author":"Wei","year":"2020","journal-title":"Clin Surg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s13304-020-00885-5","article-title":"ERAS Pathway in colorectal surgery: structured implementation program and high adherence for improved outcomes","volume":"73","author":"Catarci","year":"2021","journal-title":"Updates Surg"},{"key":"B38","doi-asserted-by":"publisher","first-page":"866041","DOI":"10.3389\/fsurg.2022.866041","article-title":"Cost-effectiveness of robotic vs. laparoscopic surgery for different surgical procedures: protocol for a prospective, multicentric study (ROBOCOSTES)","volume":"9","author":"Ielpo","year":"2022","journal-title":"Front Surg"},{"key":"B39","doi-asserted-by":"publisher","first-page":"1614654","DOI":"10.3389\/fpubh.2025.1614654","article-title":"Cost-effectiveness analysis of robotic surgery in healthcare for older individuals: a systematic review based on randomized controlled trials","volume":"13","author":"Tang","year":"2025","journal-title":"Front Public Health"},{"key":"B40","doi-asserted-by":"publisher","first-page":"2035","DOI":"10.1245\/s10434-022-12970-7","article-title":"High risk, high reward: frailty in colorectal cancer surgery is associated with worse postoperative outcomes but equivalent long-term oncologic outcomes","volume":"30","author":"Abdelfatah","year":"2023","journal-title":"Ann Surg Oncol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s40520-022-02121-z","article-title":"Handgrip strength predicts length of hospital stay in an abdominal surgical setting: the role of frailty beyond age","volume":"34","author":"Marano","year":"2022","journal-title":"Aging Clin Exp Res"},{"key":"B42","doi-asserted-by":"publisher","first-page":"102272","DOI":"10.1016\/j.arr.2024.102272","article-title":"Improving geriatric outcomes through nutritional and immunonutritional strategies: focus on surgical setting by a comprehensive evidence review","volume":"96","author":"Boccardi","year":"2024","journal-title":"Ageing Res Rev"},{"key":"B43","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1007\/s40520-025-03033-4","article-title":"Blood transfusion in older surgical patients: the only option or is there a better approach?","volume":"37","author":"Cozza","year":"2025","journal-title":"Aging Clin Exp Res"},{"key":"B44","doi-asserted-by":"publisher","first-page":"266","DOI":"10.5114\/pg.2023.129494","article-title":"The role of deep learning in diagnosing colorectal cancer","volume":"18","author":"Bousis","year":"2023","journal-title":"Prz Gastroenterol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"353","DOI":"10.5114\/pg.2023.130337","article-title":"Tissue classification and diagnosis of colorectal cancer histopathology images using deep learning algorithms. Is the time ripe for clinical practice implementation?","volume":"18","author":"Chlorogiannis","year":"2023","journal-title":"Prz Gastroenterol"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1638414\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T06:40:03Z","timestamp":1764744003000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2025.1638414\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":45,"alternative-id":["10.3389\/fsurg.2025.1638414"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2025.1638414","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]},"article-number":"1638414"}}