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Does a robotic approach decrease morbidity and mortality following pancreaticoduodenectomy for octogenarians? An
Sarah B Hays1, Kristine Kuchta2, Andres A Abreu3
1NorthShore University Health System, Department of Surgery, Evanston, IL, USA; University of Chicago, Department of Surgery, Chicago, IL, USA.
Summary
Pancreaticoduodenectomy in octogenarians has acceptable morbidity. Robotic pancreaticoduodenectomy may mitigate the increased risks associated with this procedure in older patients.
Area of Science:
- Surgical Oncology
- Geriatric Surgery
- Minimally Invasive Surgery
Background:
- Pancreaticoduodenectomy (PD) outcomes have improved, but the aging population and expanding use of robotic surgery necessitate further investigation.
- Octogenarians represent a growing demographic undergoing complex surgical procedures like PD.
Purpose of the Study:
- To compare the outcomes of octogenarians undergoing pancreaticoduodenectomy (PD).
- To evaluate whether robotic surgery offers an advantage in PD for octogenarian patients.
Main Methods:
- Multi-institutional retrospective review of patients undergoing open or robotic PD (2007-2023).
- Analysis of pre-, intra-, and post-operative outcomes.
- Multivariable analysis (MVA) and propensity score matching (PSM) were employed.
Main Results:
- Octogenarians (n=223) had higher comorbidity indices and prior surgeries compared to younger patients (n=1,952).
- Univariate analysis showed higher complication rates (Clavien-Dindo grade) and 90-day mortality in octogenarians.
- Multivariable analysis confirmed age >80 as a risk factor for major morbidity and mortality, while robotic PD was associated with decreased major morbidity.
Conclusions:
- Pancreaticoduodenectomy in octogenarians is associated with increased but acceptable morbidity.
- Robotic pancreaticoduodenectomy (RPD) may help mitigate the elevated risks in this elderly population.
