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Review
. 2024 Jan 11;16(2):323.
doi: 10.3390/cancers16020323.

Minimally Invasive Pancreaticoduodenectomy in Elderly versus Younger Patients: A Meta-Analysis

Roberto Ballarin  1 , Giuseppe Esposito  1 , Gian Piero Guerrini  1 , Paolo Magistri  1 , Barbara Catellani  1 , Cristiano Guidetti  1 , Stefano Di Sandro  1 , Fabrizio Di Benedetto  1
Affiliations
Review

Minimally Invasive Pancreaticoduodenectomy in Elderly versus Younger Patients: A Meta-Analysis

Roberto Ballarin et al. Cancers (Basel). .

Abstract

(1) Background: With ageing, the number of pancreaticoduodenectomies (PD) for benign or malignant disease is expected to increase in elderly patients. However, whether minimally invasive pancreaticoduodenectomy (MIPD) should be performed in the elderly is not clear yet and it is still debated. (2) Materials and Methods: A systematic review and meta-analysis was conducted including seven published articles comparing the technical and post-operative outcomes of MIPD in elderly versus younger patients up to December 2022. (3) Results: In total, 1378 patients were included in the meta-analysis. In term of overall and Clavien-Dindo I/II complication rates, post-operative pancreatic fistula (POPF) grade > A rates and biliary leakage, abdominal collection, post-operative bleeding and delayed gastric emptying rates, no differences emerged between the two groups. However, this study showed slightly higher intraoperative blood loss [MD 43.41, (95%CI 14.45, 72.38) p = 0.003], Clavien-Dindo ≥ III complication rates [OR 1.87, (95%CI 1.13, 3.11) p = 0.02] and mortality rates [OR 2.61, (95%CI 1.20, 5.68) p = 0.02] in the elderly compared with the younger group. Interestingly, as a minor endpoint, no differences in terms of the mean number of harvested lymphnode and of R0 resection rates were found. (4) Conclusion: MIPD seems to be relatively safe; however, there are slightly higher major morbidity, lung complication and mortality rates in elderly patients, who potentially represent the individuals that may benefit the most from the minimally invasive approach.

Keywords: elderly patients; laparoscopic pancreaticoduodenectomy; minimally invasive pancreaticoduodenectomy; minimally invasive surgery; pancreaticoduodenectomy; robotic pancreaticoduodenectomy.

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Conflict of interest statement

The authors of this study declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Operating time (min) [4,10,21,22,23,24,25].
Figure 3
Figure 3
Intraoperative blood loss (mL) [4,10,21,22,23,24,25].
Figure 4
Figure 4
Intraoperative Transfusion rate [4,21,24,25].
Figure 5
Figure 5
Conversion to Open rate [4,10,21,22,25].
Figure 6
Figure 6
Reoperation rate [4,10,21,22,23,24,25].
Figure 7
Figure 7
Perioperative Mortality rate [4,10,21,22,23,24,25].
Figure 8
Figure 8
Overall Complication rate [4,21,22,23].
Figure 9
Figure 9
Clavien–Dindo I/II rate [4,10,22,25].
Figure 10
Figure 10
Clavien–Dindo ≥ III rate [4,10,22,25].
Figure 11
Figure 11
POPF grade > A rate [4,10,21,22,23,24,25].
Figure 12
Figure 12
Biliary Leakage rate [4,21,22,23,24].
Figure 13
Figure 13
Postoperative Bleeding rate [4,10,21,22,23,25].
Figure 14
Figure 14
Delayed Gastric Empty rate [4,10,21,22,24,25].
Figure 15
Figure 15
Abdominal Collection rate [4,10,22].
Figure 16
Figure 16
Lung Morbidity rate [4,21,24].
Figure 17
Figure 17
R0 Margin rate [10,22,23,25].
Figure 18
Figure 18
Number of harvested lymphnodes [10,22,23,24,25].
Figure 19
Figure 19
Readmission rate [4,10,24,25].
Figure 20
Figure 20
Length of hospital stay [4,10,21,22,23,24,25].
See this image and copyright information in PMC

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