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Minimally Invasive Pancreaticoduodenectomy in Elderly Patients: Systematic Review and Meta-Analysis
Jisheng Zhu1, Guiyan Wang2, Peng Du1
1Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China.
Background:
Minimally invasive pancreaticoduodenectomy (MIPD) for pancreatic head or periampullary lesions is being utilized with increasing frequency. However, few data are available for the elderly. The objective of this study is to assess the safety and feasibility of MIPD in elderly population, by making a comparison with conventional open pancreaticoduodenectomy (OPD) and with non-elderly population.
Methods:
We conducted a systematic search to identify all eligible studies in Cochrane Library, Ovid, and PubMed from their inception up to April 2020.
Results:
Seven retrospective studies involving 2727 patients were included. Of these, 3 compared MIPD and OPD in elderly patients, 2 compared MIPD in elderly and non-elderly patients, and 2 included both outcomes. Compared to those with OPD, elderly patients who underwent MIPD were associated with less 90-day mortality (OR 0.56, 95% CI 0.32-0.97; P = 0.04) and fewer delayed gastric emptying (OR 0.54, 95% CI 0.33-0.88; P = 0.01). On the other hand, no significant difference was observed in terms of 30-day mortality, major morbidity, postoperative pancreatic fistula (grade B/C), postoperative hemorrhage, reoperation, 30-day readmission, and operative time. For patients who have treated with MIPD, elderly did not reveal worse outcomes than non-elderly.
Conclusion:
MIPD is a safe and feasible procedure for select elderly patients if performed by experienced surgeons from high-volume pancreatic surgery centers. However, further randomized studies are required to confirm this.
Insights
Minimally invasive pancreaticoduodenectomy (MIPD) is safe for elderly patients, showing reduced 90-day mortality and delayed gastric emptying compared to open surgery. Elderly patients undergoing MIPD have similar outcomes to younger patients.
Area of Science:
- Surgical Oncology
- Geriatric Surgery
- Minimally Invasive Surgery
Background:
- Minimally invasive pancreaticoduodenectomy (MIPD) is increasingly used for pancreatic head/periampullary lesions.
- Limited data exist on MIPD safety and feasibility in the elderly population.
- This study compares MIPD and open pancreaticoduodenectomy (OPD) in elderly patients and compares elderly vs. non-elderly MIPD outcomes.
Purpose of the Study:
- To assess the safety and feasibility of MIPD in elderly patients.
- To compare MIPD outcomes in elderly patients versus OPD.
- To compare MIPD outcomes in elderly versus non-elderly patients.
Main Methods:
- Systematic literature search of Cochrane Library, Ovid, and PubMed up to April 2020.
- Included seven retrospective studies with 2727 patients.
- Analyzed outcomes including mortality, morbidity, delayed gastric emptying, and operative time.
Main Results:
- Elderly patients undergoing MIPD had significantly less 90-day mortality (OR 0.56) and delayed gastric emptying (OR 0.54) compared to OPD.
- No significant differences were found in 30-day mortality, major morbidity, pancreatic fistula, hemorrhage, reoperation, readmission, or operative time between MIPD and OPD in the elderly.
- Elderly patients treated with MIPD showed comparable outcomes to non-elderly patients.
Conclusions:
- MIPD is a safe and feasible option for select elderly patients when performed by experienced surgeons at high-volume centers.
- Further randomized controlled trials are needed to validate these findings.
- MIPD offers potential benefits for elderly patients undergoing pancreaticoduodenectomy.
