A. A. Abreu1, A. I. Al Abbas1, J. Meier1, E. Farah1, S. C. Wang1, C. Ethun1, M. R. Porembka1, J. C. Mansour1, A. C. Yopp1, H. J. Zeh1, P. M. Polanco1 1University Of Texas Southwestern Medical Center, Surgery, Dallas, TX, USA
Introduction: The rising proportion of octogenarians in the U.S. population and an increase in pancreatic cancer diagnoses among this age group highlight a crucial healthcare concern. Pancreatoduodenectomy (PD) is the only curative treatment for pancreatic head adenocarcinoma (PDAC), with recent advances suggesting that a minimally invasive approach may have similar oncologic results with improved time to functional recovery when compared to the open technique. This study aims to compare the outcomes of the robotic vs. open surgical approach for PD in octogenarians. We hypothesized that this particular age group may benefit from the minimally invasive approach.
Methods: We conducted a retrospective analysis of patients undergoing PD for PDAC between 2015-2021, using the pancreas-specific ACS-NSQIP database. Patients were categorized as undergoing robotic or open surgery based on the approach variable. Inversed probability weighting of the propensity score was used to control for known confounding variables. Outcomes assessed include total operative time (OpT), length of stay (LOS), non-home discharge, major complications (MaC), unplanned readmission, return to OR, mortality, and clinically relevant postoperative pancreatic fistula (CRPOPF). A MaC was defined as having one of the following events: deep surgical site infection, organ space surgical site infection, dehiscence, pneumonia, unplanned intubation, pulmonary embolism, ventilator use for >48 hours, bleeding requiring transfusion within the first 72 hours of surgery, deep vein thrombosis, sepsis, septic shock, acute renal failure, cerebrovascular accident, cardiac arrest, myocardial infarction, and CR-POPF.
Results: From 30,751 patients undergoing PD, 1720 aged 80 years and older were eligible. 1625 (94%) underwent OPD, and 95 (6%) underwent robotic pancreatoduodenectomy (RPD). Patients in the RPD group had a significantly reduced incidence of major complications (32.6% vs. 45.6% in OPD; p < 0.01) and a lower rate of non-home discharge (25.3% vs. 34% in OPD; p = 0.08). However, RPD was associated with a longer operative time (438 minutes vs. 342 minutes for OPD; p < 0.0001). Mortality rates, postoperative pancreatic fistula, and length of stay were similar for both approaches.
Conclusion: RPD is associated with reduced major postoperative complications and non-home discharges compared to the traditional open approach in octogenarian patients. These findings suggest that RPD is a favorable option in the vulnerable octogenarian population undergoing surgery for PDAC.
