Short‑ and long‑term outcomes after laparoscopic and open pancreatoduodenectomy for elderly patients: a propensity...

Area of Science:

• Surgical Oncology
• Geriatric Surgery
• Minimally Invasive Surgery

Background:

• The safety and efficacy of laparoscopic pancreatoduodenectomy (LPD) in elderly patients (≥65 years) remain debated.
• This study compares clinical outcomes of LPD versus open pancreatoduodenectomy (OPD) in this demographic.

Purpose of the Study:

• To evaluate the feasibility and safety of LPD compared to OPD in elderly patients.
• To identify prognostic factors for 90-day mortality after pancreatoduodenectomy in older adults.

Main Methods:

• Retrospective analysis of clinical data from elderly patients undergoing LPD or OPD (2015-2022).
• Propensity score-matching (1:1) to control for confounding variables.
• Logistic regression analysis to determine independent prognostic factors for 90-day mortality.

Main Results:

• After propensity score-matching, LPD showed significantly less estimated blood loss (EBL), lower intraoperative transfusion rates, and shorter postoperative length of stay (LOS).
• Lymph node harvest was higher in the LPD group.
• No significant differences were observed in serious complications, reoperation, readmission, or 90-day mortality rates between LPD and OPD.
• Post-pancreatectomy hemorrhage (PPH) was identified as an independent risk factor for 90-day mortality.
• Overall survival (OS) was similar for elderly pancreatic ductal adenocarcinoma (PDAC) patients undergoing LPD or OPD.

Conclusions:

• Laparoscopic pancreatoduodenectomy is a safe and feasible option for elderly patients, associated with reduced EBL and shorter LOS.
• No significant difference in long-term survival outcomes exists between LPD and OPD for elderly PDAC patients.