Laparoscopic and robotic surgery in the elderly—is there a difference in outcomes?

Summary Background As populations age, the number of older adults undergoing major abdominal surgery increases. Age alone poorly predicts outcomes; measures of physiological reserve and frailty are more robust parameters. Minimally invasive surgery (MIS), a general term including laparoscopic (LS) and increasingly robot-assisted surgery (RAS), may reduce surgical stress and improve recovery, but their relative benefits in elderly cohorts remain variably defined. Methods We conducted a narrative review of PubMed, emphasizing meta-analyses and propensity score-matched cohort studies comparing LS, RAS, and open approaches in older adults across common visceral indications. No additional statistical analyses were performed. Results Laparoscopic surgery reduces surgical stress and is consistently associated with reduced blood loss, faster bowel recovery, a shorter length of hospital stay, and lower postoperative morbidity versus open surgery, with adequate oncologic results. Frailty—not age—best stratifies risk and correlates with mortality, complications, delirium, and prolonged hospitalization. Evidence for RAS in the elderly is growing; it generally demonstrates feasibility and similar results to laparoscopy, with a tendency toward lower blood loss and shorter stays in selected procedures, counterbalanced by longer operative times associated with a higher rate of postoperative pulmonary complications. High-quality comparative data specific to frail older patients remain limited. Conclusion Advanced age alone should not exclude MIS. When oncologically and technically feasible within an acceptable operative time, MIS should also be the standard approach in elderly patients. Frailty assessment should guide decision-making. The existing data on RAS are promising but require further geriatric-focused studies to reach definitive conclusions.