Does a robotic approach decrease morbidity and mortality following pancreaticoduodenectomy for octogenarians? An American multi-center analysis
- PMID: 40813199
- DOI: 10.1016/j.hpb.2025.07.016
Does a robotic approach decrease morbidity and mortality following pancreaticoduodenectomy for octogenarians? An American multi-center analysis
Abstract
Background: Morbidity and mortality following pancreaticoduodenectomy (PD) have improved; however, the population is aging, and the use of robotic surgery is expanding. This study compares the selection of octogenarians who underwent PD, their outcomes, and whether robotic surgery provides an advantage.
Methods: This is a multi-institutional retrospective review from 2007 to 2023 of patients who underwent PD, including open and robotic approach. Pre-, intra-, and post-operative outcomes were analyzed; multivariable analysis (MVA) and propensity score matching (PSM) were performed.
Results: 2175 patients underwent PD for all causes; <80 years: n=1,952, >80 (octogenarians): n=223. Octogenarians had higher age unadjusted Charlson Comorbidity Index (2.8 vs 2.6, p<0.001), and more prior surgeries (67.9 % vs 56.1 %, p<0.001). On univariate analysis, octogenarians had higher average Clavien-Dindo grade (2.0 vs 1.7, p=0.002) and higher 90-day mortality (9.9 % vs 3.1 %, p<0.001). On MVA, age >80 was associated with increased risk of major morbidity (OR 1.50 [1.10-2.04], p=0.011) and 90-day mortality (OR 3.20 [1.85-5.54], p<0.001). Robotic PD (RPD) was associated with decreased risk of major morbidity (OR 0.69 [0.56-0.86], p<0.001). After PSM of octogenarians who underwent RPD, there was no statistically significant difference in mortality.
Conclusion: Pancreaticoduodenectomy has increased but acceptable morbidity in octogenarians. The increased risk may be mitigated by RPD.
Copyright © 2025 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
Conflict of interest statement
Conflicts of interest Dr. Melissa Hogg has received funding from Intuitive Surgical, Inc. to NorthShore University HealthSystem for education and training, she serves as a consultant for Olympus Corporation. Dr. Polanco has served as an Intuitive Surgical, Inc. proctor and is a consultant for Medtronic and Iota Biomedical. Dr. Zeh serves on the scientific advisory board for Surgical Safety Technologies. All other authors have no disclosures. All other authors (SH, KK, AA, AC, EF, AK, SM, IR, KR, AR, AT, BB, AP, CS, MT, AZ) have no disclosures to report.
Similar articles
-
Prescription of Controlled Substances: Benefits and Risks.2025 Jul 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. 2025 Jul 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30726003 Free Books & Documents.
-
Effect of robotic versus open pancreaticoduodenectomy on postoperative length of hospital stay and complications for pancreatic head or periampullary tumours: a multicentre, open-label randomised controlled trial.Lancet Gastroenterol Hepatol. 2024 May;9(5):428-437. doi: 10.1016/S2468-1253(24)00005-0. Epub 2024 Feb 28. Lancet Gastroenterol Hepatol. 2024. PMID: 38428441 Clinical Trial.
-
Postoperative nutritional support after pancreaticoduodenectomy in adults.Cochrane Database Syst Rev. 2025 Mar 14;3(3):CD014792. doi: 10.1002/14651858.CD014792.pub2. Cochrane Database Syst Rev. 2025. PMID: 40084692
-
The effectiveness and cost-effectiveness of carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma: a systematic review and economic evaluation.Health Technol Assess. 2007 Nov;11(45):iii-iv, ix-221. doi: 10.3310/hta11450. Health Technol Assess. 2007. PMID: 17999840
-
What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature.Health Technol Assess. 2012 Dec;16(50):i-xvi, 1-159. doi: 10.3310/hta16500. Health Technol Assess. 2012. PMID: 23302507 Free PMC article.
LinkOut - more resources
Full Text Sources
Miscellaneous