Clinical Report: Comparison of Robotic and Open Approaches to Pancreaticoduodenectomy in Older Adults

Overview

This meta-analysis compares the perioperative outcomes of robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) in elderly patients. The analysis included 6 studies with 2,965 patients, showing that RPD had lower overall morbidity (OR 0.45, 95% CI 0.22–0.92), fewer major complications (OR 0.68, 95% CI 0.49–0.94), less intraoperative blood loss (MD -119.25 mL, 95% CI -141.36 to -97.14), lower blood transfusion rates (OR 0.50, 95% CI 0.34–0.72), and shorter hospital stays (MD -1.63 days, 95% CI -2.88 to -0.38) compared to OPD.

Background

The aging population is increasingly being considered for pancreaticoduodenectomy (PD), a complex surgical procedure associated with significant morbidity and mortality. Elderly patients often present with comorbidities that heighten their risk during surgery. Understanding the safety and efficacy of robotic versus open approaches in this demographic is crucial for optimizing surgical outcomes, as evidenced by studies showing higher complication rates in elderly patients undergoing PD.

Data Highlights

Key Findings

• RPD is associated with lower overall morbidity compared to OPD.
• Fewer major complications were observed in the RPD group.
• RPD resulted in less intraoperative blood loss than OPD.
• Lower blood transfusion rates were noted in patients undergoing RPD.
• Patients undergoing RPD had a shorter hospital stay compared to those undergoing OPD.
• No significant differences were found in mortality rates between RPD and OPD.

Clinical Implications

Surgeons should consider the comparative outcomes of RPD and OPD when discussing surgical options with elderly patients, based on the findings of this meta-analysis.

Conclusion

This study provides evidence that RPD may offer several perioperative advantages over OPD in elderly patients. Further high-quality randomized controlled trials are needed to validate these findings.

Related Resources & Content

1. Updates in Surgery, 2020 -- Comprehensive Review and Updated Network Meta-Analysis of Open, Laparoscopic, and Robotic Approaches to Pancreaticoduodenectomy
2. Updates in Surgery, 2026 -- Robotic versus open pancreatoduodenectomy (SPAIN Trial): protocol for a multicenter randomized controlled trial assessing safety, efficacy and cost-effectiveness
3. Surgical Endoscopy, 2025 -- Comparative Effectiveness of Robotic Versus Open Pancreaticoduodenectomy in Patients with Elevated PD-ROBOSCORE
4. Evaluation of a Modified Frailty Index for Risk Assessment in Older Adults Undergoing Distal Pancreatectomy: A Retrospective Study from a Single Institution
5. NCCN Guidelines for Pancreatic Cancer
6. São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer
7. Perioperative Care for Patients with Frailty
8. Robotic versus Open Pancreatoduodenectomy (PORTAL): multicentre, single masked, phase 3, non-inferiority randomised controlled trial | The BMJ
9. Robotic pancreatoduodenectomy: gaps in evidence need to be addressed before it can be adopted more widely | The BMJ
10. Non-inferiority of robotic versus open pancreatoduodenectomy — a systematic review and meta-analysis of prospective non-randomized and randomized trials - PMC
11. TTP4.06 Open, Laparoscopic, and Robotic Pancreaticoduodenectomy: A Systematic Review | BJS | Oxford Academic
12. Robotic pancreatoduodenectomy in elderly individuals: An international multicenter propensity score–matched study by the PANFRAIL Collaborative group - Surgery
13. Robotic Pancreaticoduodenectomy in Elderly vs. Younger Patients: Systematic Review with Meta-Analysis - PMC
14. Meta-Analysis of Short-Term Outcomes After Robotic Pancreaticoduodenectomy in Octogenarians - PubMed
15. Laparoscopic versus open pancreaticoduodenectomy outcomes in patients ≥ 75 years old: an NSQIP analysis of 4343 patients - ScienceDirect
16. Comparative 30-day mortality and complications in robotic vs. open pancreaticoduodenectomy with portal-mesenteric vein resection: a systematic review and meta-analysis - PubMed