Robotic Pancreaticoduodenectomy in Elderly vs. Younger Patients: Systematic Review with Meta-Analysis

Background: As life expectancy increases, more elderly patients require a pancreaticoduodenectomy (PD). While minimally invasive approaches are preferred, data indicating the safety of robotic PD in elderly patients remains limited. This study compares operative outcomes of robotic PD in elderly versus younger patients to define its oncological role. Material and Methods: A systematic search of PubMed, Embase, Web of Science, and Scopus identified studies comparing robotic pancreaticoduodenectomy in elderly versus younger patients. Robotic-exclusive cohorts were analyzed for perioperative outcomes, complications, and mortality. A meta-analysis was performed using R to calculate pooled prevalences, Odds Ratios (ORs) and Weighted Mean Differences (WMDs). Results: Elderly patients experienced significantly longer operative times (MD = 11.4 min) and hospital stays (MD = 7.76 days). They demonstrated higher odds of severe complications (Clavien-Dindo ≥ III: OR = 2.20), delayed gastric emptying (DGE) (OR = 2.34), and mortality (OR = 3.42). There were no significant differences in blood loss, transfusions, overall complications, pancreatic fistulae, bile leakage, hemorrhage, infection, readmission, or reoperation. Notably, age-stratified subgroup analyses revealed a distinct risk divergence: studies using an 80-year cutoff reported significantly higher odds of mortality and DGE, whereas 70-year-threshold studies demonstrated more pronounced odds for severe and overall complications. Conclusions: While robotic pancreaticoduodenectomy is feasible in elderly patients with comparable intraoperative blood loss and overall complication rates to younger patients, it does not eliminate all age-related risks. Elderly patients remain at significantly higher risk for severe complications and mortality. Therefore, robotic application in this demographic requires rigorous preoperative assessment, utilizing age as an initial risk-stratifier while allowing physiological reserve to determine final surgical candidacy.