Robotic pancreatoduodenectomy in elderly individuals: An international multicenter propensity score–matched study by the PANFRAIL Collaborative group

Introduction As life expectancy rises, more elderly patients are considered for major abdominal surgeries. Pancreatoduodenectomy in octogenarians remains challenging because of comorbidities and reduced physiological reserve. Although minimally invasive techniques such as robotic surgery may offer advantages, evidence specific to this elderly population is scarce. This study aimed to evaluate surgical outcomes in patients aged ≥80 years undergoing pancreatoduodenectomy and to compare perioperative results between robotic and open approaches. Material and Methods This multicenter retrospective study included consecutive patients aged ≥80 years who underwent robotic or open pancreatoduodenectomy across 37 international centers between January 2012 and December 2024. Propensity score matching (1:1) was performed, yielding 2 comparable cohorts of 109 patients each. Perioperative outcomes were analyzed and compared. Results Robotic pancreatoduodenectomy was associated with longer operative time (441 vs 375 minutes, P <.001) but significantly lower estimated blood loss (266 vs 565 mL, P <.001). Compared with the open group, the robotic approach showed lower rates of overall postoperative complications (52.2% vs 70.6%, P =.013), clinically relevant postoperative pancreatic fistula (9.3% vs 29.4%, P <.001), median comprehensive complication index (16 vs 24, P =.027), and shorter hospital stay (13 vs 21 days, P =.002). No significant differences were observed in 30-day (4.6% vs 6.4%, P =.180) or 90-day mortality (5.5% vs 6.4%, P =.769). Conclusions Robotic pancreatoduodenectomy appears safe and is associated with improved perioperative outcomes in octogenarians. When performed in experienced centers, the robotic approach may represent a preferable option in this elderly population.