RERAS: does age define recovery? The role of patient characteristics and ERAS protocols in robotic colorectal surgery

Age is frequently considered a major determinant of postoperative recovery after colorectal surgery and is often perceived as a limiting factor for an enhanced recovery after surgery (ERAS^®) pathway. The integration of ERAS^® with a robotic surgical approach (RERAS-concept) may be associated with synergistic effects especially for this group of patients. However, real-world-data evaluating age-related differences in postoperative recovery under RERAS conditions remain limited. This retrospective analysis of a prospectively maintained database included all elective robotic colorectal resections performed between January 2019 and April 2024 under a fully standardized ERAS^®-protocol. Patients were categorized into younger (≤ 69 years) and older (≥ 70 years) adults. The primary endpoint was the comparison of short-term perioperative outcomes. Secondary endpoints comprised functional recovery parameters and perioperative ERAS^® compliance. 344 robotic colorectal resections were analyzed (219 colon and 125 rectal resections). Older adults presented with increased frailty levels across both colon and rectal resections (mFI-5 all p = < 0.0001). In colon resections, this was accompanied by significantly higher preoperative risk profiles, reflected by a greater proportion of ASA III patients (72.1% vs. 40.7%; p < 0.0001), while intraoperative characteristics, postoperative morbidity and length of hospital stay were comparable between age groups. Older adults achieved oral pain control earlier (1 vs. 2 days; p = 0.0410), reported lower postoperative pain scores from the day of surgery through postoperative day 3 (all p < 0.05) and demonstrated greater mobilization on postoperative day 3 (6 vs. 5 h; p = 0.0298). In rectal resections, younger patients more frequently received neoadjuvant therapy (59.1% vs. 39%; p = 0.0248). Duration of surgery was shorter in older adults (229 vs. 245 min; p = 0.0176), while the other endpoints were comparable between cohorts. In this real-world cohort, robotic colorectal surgery within a standardized ERAS^® pathway resulted in comparable postoperative recovery across age groups, with statistically significant advantages in pain control and mobilization favoring older adults, supporting age-independent implementation of the RERAS concept.