Short-term Outcomes after Minimally Invasive versus Open Pancreaticoduodenectomy in Elderly Patients: a Propensity Score-matched Analysis

Abstract

Background: To date, the evidence on the safety and benefits of minimally invasive pancreatoduodenectomy (MIPD) in elderly patients is still controversy. This study aim to compare the risk and benefit between MIPD and open pancreatoduodenectomy (OPD) in elderly patients. Methods: From 2016 to 2020, we retrospective enrolled 26 patients underwent MIPD and other 119 patients underwent OPD. Propensity score matching was applied for old age (≥ 65-year-old) patient analysis. Baseline characteristics, 90-day mortality and short-term surgical outcomes were compared between two groups. Results: After 1:2 propensity score matching analysis, elderly patients in MIPD group had significantly poor performance status (P = 0.042) compared to OPD group. Patients receiving MIPD had significantly shorter postoperative hospital stay (POHS) (18 vs. 25 days, P = 0.028), earlier drain removal (16 vs. 21 days, P = 0.012) and smaller delay gastric empty rate (5.9 vs. 32.4% P = 0.036). There was no 90-day mortality (0% vs 11.8%, P = 0.186) and pulmonary complications (0% vs 17.6%, P = 0.075) in MIPD group, and the major complication rate is comparable to OPD group (17.6% vs 29.4%, P = 0.290). Conclusion: For elderly patients, MIPD is a feasible and safe option even in patients with inferior preoperative performance status. MIPD might also provide potential advantage for elderly patients in minimizing pulmonary complication and overall mortality over OPD.