Evaluating the role of surgical approach in frail patients undergoing distal pancreatectomy for intraductal papillary mucinous neoplasms.

BACKGROUND

Minimally invasive surgery has been associated with reduced postoperative morbidity compared with traditional open approaches, suggesting that it may be advantageous for patients with frailty. However, its effect on individuals with frailty with intraductal papillary mucinous neoplasms (IPMNs) undergoing distal pancreatectomy (DP) remains unclear. This study aimed to evaluate the association between surgical approach and postoperative outcomes in the context of patient frailty.

METHODS

Using the American College of Surgeons National Surgical Quality Improvement Program database, 1120 patients with nonmalignant IPMN who underwent DP between 2019 and 2023 were identified. Frailty was defined as a modified frailty index (mFI) of ≥2, calculated using 5 variables: diabetes mellitus, hypertension, functional dependency, chronic obstructive pulmonary disease, and congestive heart failure. Patients were categorized according to their frailty status and surgical approach (minimally invasive surgery [MIS] vs open surgery). Postoperative outcomes, including complications, major complications, readmission, reoperation, and mortality, were compared between the groups using univariate and multivariate analyses.

RESULTS

Patients with frailty consisted of 27.7% of the cohort (n = 310) and were more likely to experience complications (35.1% in patients with frailty vs 28.4% in patients without frailty; P =.042) and longer hospital stay (mean: 5.9 days in patients with frailty vs 5.3 days in patients without frailty; P =.009). In the overall cohort, frailty independently predicted higher odds of complications (odds ratio [OR], 1.44 [95% CI, 1.05-1.97]) and readmission (OR, 1.68 [95% CI, 1.16-2.45]), whereas male sex and older age were associated with increased mortality. MIS was not associated with reduced odds of complications, readmission, reoperation, or mortality in populations with or without frailty.

CONCLUSION

Frailty is an independent predictor of complications and readmission after DP for IPMN. However, MIS does not seem to confer benefits over open surgery in patients with or without frailty.