Meta-Analysis of Short-Term Outcomes After Robotic Pancreaticoduodenectomy in Octogenarians

Background/Objectives: To evaluate short-term postoperative outcomes in octogenarians undergoing robotic pancreaticoduodenectomy. Methods: In compliance with the PRISMA statement standards, a systematic review and random-effects meta-analysis was conducted. All studies reporting short-term postoperative outcomes in patients aged ≥ 80 undergoing robotic pancreaticoduodenectomy were included and analyzed. Results: A total of 321 octogenarians from five studies were included. The mean operative time was 459.7 min (95% CI 398.6-520.8) and the estimated intraoperative blood loss was 216.1 mL (95% CI 147.4-284.8). Conversion to open occurred in 3.8% (95% CI 0.0-7.7). The risk of postoperative mortality was 4.5% (95% CI 1.7-7.2) and Clavien-Dindo grade ≥ III (major) complications occurred in 28.0% (95% CI 22.9-33.1). The risk of grade B or C postoperative pancreatic fistula was 10% (95% CI 6.5-13.5). The hospital stay was 14.9 days (95% CI 10.2-19.5). The risk of reoperation and readmission were 8.0% (95% CI 4.4-11.7) and 25.6% (95% CI 16.9-34.3), respectively. Compared to patients aged <80, the risk of major complications was higher (OR: 1.81, p = 0.010) and hospital stay was longer (MD: 5.19 days, p = 0.030) in octogenarians. Compared to the open approach, robotic approach was associated with longer operative time (MD: 137.08 min, p = 0.0009), less intraoperative blood loss (MD: -246.00 mL, p = 0.010), and lower major complications (OR: 0.62, p = 0.020). Conclusions: Subject to selection and confounding bias, robotic pancreaticoduodenectomy may be safe with acceptable postoperative mortality and morbidity in highly selected octogenarians with good performance status. The results of the current study can be used for hypothesis synthesis and power analysis in future comparative studies.