Robotic versus open pancreaticoduodenectomy in elderly patients: a meta-analysis.

OBJECTIVE

With the aging population and increasing indications for pancreatic surgery, more elderly patients are being considered for pancreaticoduodenectomy (PD). Robotic pancreaticoduodenectomy (RPD) has been increasingly adopted; however, its safety and efficacy in elderly patients remain controversial. This systematic review and meta-analysis aimed to compare the perioperative outcomes of RPD versus open pancreaticoduodenectomy (OPD) in elderly patients.

METHODS

A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered in PROSPERO. PubMed, Cochrane Library, Scopus, EMBASE, and Web of Science were searched from inception to February 18, 2026. Studies comparing RPD and OPD in elderly patients were included. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

RESULTS

A total of 6 studies including 2, 965 patients (RPD group: 482 patients; OPD group: 2, 483 patients) were included. Compared with the OPD group, the RPD group 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 stay (MD, -1.63 days; 95% CI, -2.88 to -0.38). No significant differences were observed between the groups in mortality (OR, 0.99; 95% CI, 0.54-1.82), operative time (MD, 100.76 min; 95% CI, -57.92 to 259.43), postoperative pancreatic fistula (OR, 0.69; 95% CI, 0.48-1.00), delayed gastric emptying (OR, 1.42; 95% CI, 0.99-2.02), or reoperation rates (OR, 1.24; 95% CI, 0.72-2.13).

CONCLUSIONS

This study suggests that RPD is a safe and feasible approach for elderly patients, with perioperative outcomes comparable to those of OPD. Additionally, RPD may be associated with reduced postoperative morbidity, less intraoperative blood loss, lower transfusion requirements, and shorter hospital stay. High-quality randomized controlled trials are warranted to validate these findings and further assess long-term outcomes.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261444617.