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INTRODUCTION Surgical resection is the mainstay of the curative treatments for colorectal cancer, and the last 30 years, have witnessed the introduction and development of new technologies and an increasing move towards minimally invasive techniques. Several studies demonstrate the advantages of minimally invasive colonic resections in improving short-term postoperative outcomes. However, when considering the clinical management of elderly patients, realizing the impact of age and frailty on postoperative outcomes is important for guiding treatment decisions. Currently, because there are no detailed guidelines by age group, the treatment strategy for elderly patients with CRC depends on the policies of each institution and surgeon. The aim of this study was to investigate the safety and feasibility of minimally invasive right hemicolectomy for elderly patients with colon cancer aged over 75 years by retrospectively comparing their operative outcomes with those of the non-elderly using a propensity score matching (PSM) model based on age and Charlson Comorbidity Index (CCI). MATERIALS AND METHODS This is a multicenter retrospective study combining four prospectively maintained databases of consecutive patients undergoing elective right hemicolectomy between January 2013 and December 2020. The primary endpoint of the study was to analyse the short-term postoperative results of minimally invasive right hemicolectomy in elderly patients. The incidence of major surgical complications, defined as Clavien-Dindo III-IV grade complications, represented the primary outcome. Secondary outcomes included risk factors for complications and prolonged operative time. Patients were divided into three groups according to their age at the time of the operation: Group I (control group, < 60 years), Group II (>60-75), Group III (≧75). The patients were further divided according to the operative approach used: Laparoscopic (LrH) or Robotic (RrH) and Open resection (OrH). Variables baseline demographic data (gender, Body Mass Index(BMI), American Society of Anaestesiologists (ASA) grade, Charlson Comorbidity Index (CCI), comorbidities, Previous abdominal surgery, CT location, size and stage of the tumour), intra-operative data (operative time, intra-operative complications, need and causes of conversion) and post-operative course (post-operative complications, time to flatus and length of stay) were investigated. Need for readmission and 90-days mortality were also included. Similar datapoints were gleaned from patients undergoing open right hemicolectomy procedures in the same time period. RESULTS Of the 618 included patients, 267 (43.2%) were aged between 60 and 75 years, while 268 (43.4 %) were older than 75 years. According to the type of procedure, 337 (54.5) patients underwent LrH, 144 (23.3%) had a robotic procedure and in the remaining 137 (22.2%) an open approach was used. These groups statistically differed for BMI (p=0.0079), location of the tumour at the pre-operative CT scan and size of the tumour (p=0.0140). Analyzing the operative outcomes in patients aged > 60 years who had undergone a minimally invasive resection (LrH or RrH), there were no statistical differences for both operative time (p=0.148) and rate of intraoperative complications (p=0.938) between Group II and III. Regarding the post-operative course, the age groups II and III did not differ for short term major surgical complications rate (p=0.392), nor for general major complications (13 Vs 8; p=0.380), no significative differences were noted in the incidence of Clavien Dindo III complications (8 vs 11; p=0.646). Class I and II complications according to Clavien-Dindo classification were higher in the age Group II. Length of hospital stay and readmission rate were comparable between the two groups (p=0.944 and p= 0.308 respectively). None of the post-operative parameters analyzed differed when comparing LrH and RrH. Mortality was not observed in the short term (within the first admission) nor in the long term (90 days after the operation). When comparing patients aged > 60 who had undergone open or minimally invasive procedures (LrH/RrH) a statistically significant difference in intraoperative complications (6 vs 1; p=0.011) and estimated intra-operative blood loss (p=0.001) was observed. The rate of post-operative complications was significantly higher in the OrH group (40 vs 82; p=0.22) considering both surgical and general complications (p= 0.039 and p<0.0001, respectively). Mortality at 90 days from the operation was observed in 5 patients (3.8%) in the OrH group. Male gender and tumour location were identified as risk factors for prolonged operative time at univariate analysis but not in the multivariate analysis. Open procedures were associated with operative time >180 min in both univariate and multivariate analysis. Conversion to open surgery resulted as a risk factor for complication occurrence and class III complications in both univariate and multivariate analyses, while open procedure was a risk factor for Class III only at univariate analysis. CONCLUSIONS These results suggest that indication for laparoscopic surgery should not be abandoned for elderly patients solely based on older age. Meanwhile, older people tend to have a variety of underlying conditions and poorer general health than younger people. Therefore, elderly patients need thorough care and pre-operative planning, including rehabilitation and palliative care considerations. The decision of optimal surgical procedure should be taken based on the individual patient condition, life expectancy, and patient’s wishes and not specifically based on patient age

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