Robotic versus open pancreaticoduodenectomy in elderly patients: a propensity score-matched analysis

Michael A Mederos; Savannah Starr; Joon Y Park; Jonathan C King; James S Tomlinson; O J Hines; Timothy R Donahue; Mark D Girgis

doi:10.1016/j.hpb.2022.11.011

Robotic versus open pancreaticoduodenectomy in elderly patients: a propensity score-matched analysis

HPB (Oxford). 2023 Mar;25(3):301-310. doi: 10.1016/j.hpb.2022.11.011. Epub 2022 Dec 5.

Authors

Michael A Mederos¹, Savannah Starr², Joon Y Park³, Jonathan C King⁴, James S Tomlinson⁵, O J Hines⁴, Timothy R Donahue⁴, Mark D Girgis⁵

Affiliations

¹ David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA. Electronic address: mmederos@mednet.ucla.edu.
² David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
³ David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA.
⁴ David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Division of Surgical Oncology, Los Angeles, CA, USA.
⁵ David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Division of Surgical Oncology, Los Angeles, CA, USA; VA Greater Los Angeles Healthcare System, Surgical Oncology, Los Angeles, CA, USA.

PMID: 36529625
DOI: 10.1016/j.hpb.2022.11.011

Abstract

Background: Pancreaticoduodenectomy (PD) is complex procedure with high morbidity in the elderly. This retrospective study aimed to compare post-operative outcomes in patients ≥75 years of age who underwent robot-assisted (RA)PD and open PD.

Methods: We analyzed 2502 patients ≥75 years of age who underwent PD from 2015 to 2018 in the National Surgical Quality Improvement Program (NSQIP) database. RAPD and open PD patients were propensity score matched 1:5 to assess the 30-day outcomes of interest: postoperative complications, length of stay, discharge destination, and readmissions.

Results: Of 725 matched patients, 110 underwent RAPD, 615 OPD, and 12 were converted to an open operation. Post-operative outcomes were largely similar between cohorts. RAPD was associated a shorter length of stay (median 8 days, interquartile range [IQR] 6 to 11) than OPD (median 8 days, IQR 7 to 13) (p = 0.003). However, RAPD was associated with more readmissions (28.1% vs. 17.7%; p = 0.02).

Conclusions: RAPD in patients ≥75 years of age appears to be safe and has a similar complication profile to open PD. Randomized or well-designed prospective matched studies are needed to confirm these findings.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Humans
Laparoscopy* / adverse effects
Length of Stay
Pancreatic Neoplasms* / surgery
Pancreaticoduodenectomy / adverse effects
Postoperative Complications / etiology
Propensity Score
Prospective Studies
Random Amplified Polymorphic DNA Technique
Retrospective Studies
Robotic Surgical Procedures* / adverse effects
Robotics*