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. 2025 Jul 30:S1365-182X(25)00675-6.
doi: 10.1016/j.hpb.2025.07.016. Online ahead of print.

Does a robotic approach decrease morbidity and mortality following pancreaticoduodenectomy for octogenarians? An American multi-center analysis

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Does a robotic approach decrease morbidity and mortality following pancreaticoduodenectomy for octogenarians? An American multi-center analysis

Sarah B Hays et al. HPB (Oxford). .

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.

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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.

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