Evaluating Laparoscopic and Robotic Liver Resection in Elderly Patients: A NSQIP Analysis of Short-Term Outcomes.

Introduction: Results of minimally invasive laparoscopic (LLR) and robotic liver resection (RLR) have been promising, but the benefits in the elderly patients are still unclear. This study aims to compare short-term outcomes of LLR and RLR in elderly patients.

Methods: The 2017-2021 NSQIP database was analyzed comparing patients ≥ 65 years old undergoing LLR versus RLR. Postoperative outcomes, factors associated with complications and mortality were assessed using propensity score matched (PSM) and multivariable logistic regression.

Results: We analyzed 2,210 patients undergoing LLR (n = 1865,84.4%) and RLR (n = 345,15.6%). Patients undergoing LLR were older (72.4 vs. 71.8 years; p = 0.04) and more likely to have ASA 4 (11.1% vs. 4.9%; p = 0.001). RLR patients had shorter hospital stays (3.5 vs. 4.4 days; p < 0.001) but longer operative durations (221.4 vs. 203.5 min; p = 0.013). On adjusted analyses, RLR was not associated with increased odds of serious complications (OR: 0.82, CI95% 0.42-1.58, p = 0.545) or mortality (OR: 0.87, p = 0.851). After PSM, RLR statistically reduced length of stay (-0.72 days; p = 0.012) but increased operative times ( + 32.62 min; p < 0.001). Subgroup analysis of patients ≥ 75 years confirmed consistent findings.

Conclusions: RLR provides comparable safety and short-term outcomes to LLR, offering shorter hospital stays but longer operative durations. Findings support RLR as a viable option in elderly patients, but further studies evaluating long-term outcomes are warranted.