Comparison of clinical outcomes and quality of life for robotic versus laparoscopic surgery in elderly patients with mid-low rectal cancer: a multicenter cohort study with inverse probability of treatment weighting analysis

Background: The rising incidence of rectal cancer (RC) in elderly patients contrasts with the scarcity of robust evidence comparing robotic-assisted and laparoscopic resection in this population. This study evaluated clinical outcomes and quality-of-life (QoL) metrics between these approaches in elderly patients with mid-low RC. Methods: Consecutive patients aged 70 years or older with mid-low RC who underwent minimally invasive resection at two tertiary centers from January 2017 to December 2024 were categorized into robotic (n=211) and laparoscopic (n=812) cohorts. Outcomes were analyzed using inverse probability of treatment weighting (IPTW) based on propensity scores. Results: < 0.05). For patients with T4 stage tumors, the robotic approach demonstrated superior cancer-specific survival compared to laparoscopy, a benefit that was maintained after IPTW. Conclusions: Robotic-assisted surgery is a safe and feasible alternative for elderly patients with mid-low RC, offering reduced perioperative complications, superior functional preservation, and potential CSS benefits in T4 disease.