Background: With the advances in surgical techniques and perioperative management, the surgical indications for pancreaticoduodenectomy have been extended to elderly patients. Whether robotic pancreaticoduodenectomy (RPD) is superior to open pancreaticoduodenectomy (OPD) in older patients remains uncertain. Thus, this study aimed to compare perioperative outcomes between RPD and OPD in elderly patients.

Methods: The demographics and perioperative outcomes of a consecutive series of elderly patients (aged ≥75 years) who underwent RPD or OPD at seven pancreatic centers in China between July 2011 and July 2020 were retrospectively analyzed.

Results: Of the 302 patients included in this study, 169 underwent RPD and 133 underwent OPD. The RPD group had a shorter operative time (OT) (264.3 vs. 278.2 min, P = 0.01) and less estimated blood loss (EBL) (100 (50 150) vs. 200 (150 300) mL, P < 0.001) than the OPD group. RPDs in 3 (1.8%) patients were converted to OPD. The postoperative length of stay (LOS) after RPD was significantly shorter than that after OPD (13.0 vs. 17.0 days, P < 0.001). No significant differences were found in the rates of clinically relevant postoperative pancreatic fistula, bile leakage, delayed gastric emptying, postoperative pancreatectomy hemorrhage, major morbidity, reoperation, 90-day readmission, or 90-day mortality between the two groups (P > 0.05). The multivariate logistic regression analysis revealed that type 2 diabetes, chronic obstructive pulmonary disease, postoperative hemorrhage, and cardiac events were independent risk factors for postoperative 90-day mortality.

Conclusions: This study demonstrated that RPD was comparable to OPD in terms of safety and feasibility in elderly patients with shorter OT, lower EBL, and shorter postoperative LOS. Surgical approach was not an independent risk factor for 90-day mortality.