(1) Background: With ageing, the number of pancreaticoduodenectomies (PD) for benign or malignant disease is expected to increase in elderly patients. However, whether minimally invasive pancreaticoduodenectomy (MIPD) should be performed in the elderly is not clear yet and it is still debated. (2) Materials and Methods: A systematic review and meta-analysis was conducted including seven published articles comparing the technical and post-operative outcomes of MIPD in elderly versus younger patients up to December 2022. (3) Results: In total, 1378 patients were included in the meta-analysis. In term of overall and Clavien–Dindo I/II complication rates, post-operative pancreatic fistula (POPF) grade > A rates and biliary leakage, abdominal collection, post-operative bleeding and delayed gastric emptying rates, no differences emerged between the two groups. However, this study showed slightly higher intraoperative blood loss [MD 43.41, (95%CI 14.45, 72.38)p= 0.003], Clavien–Dindo ≥ III complication rates [OR 1.87, (95%CI 1.13, 3.11)p= 0.02] and mortality rates [OR 2.61, (95%CI 1.20, 5.68)p= 0.02] in the elderly compared with the younger group. Interestingly, as a minor endpoint, no differences in terms of the mean number of harvested lymphnode and of R0 resection rates were found. (4) Conclusion: MIPD seems to be relatively safe; however, there are slightly higher major morbidity, lung complication and mortality rates in elderly patients, who potentially represent the individuals that may benefit the most from the minimally invasive approach.
(1) 背景：随着人口老龄化，针对良恶性疾病行胰十二指肠切除术（PD）的老年患者数量预计将增加。然而，是否应在老年患者中实施微创胰十二指肠切除术（MIPD）尚不明确，目前仍存在争议。(2) 材料与方法：本研究进行了系统性回顾与荟萃分析，纳入截至2022年12月发表的7篇文献，比较了老年与年轻患者接受MIPD的技术及术后结局。(3) 结果：荟萃分析共纳入1378例患者。在总体并发症发生率、Clavien–Dindo I/II级并发症发生率、术后胰瘘（POPF）>A级发生率、胆漏、腹腔积液、术后出血及胃排空延迟发生率方面，两组间均无显著差异。然而，本研究发现老年组相较于年轻组存在略高的术中失血量[MD 43.41, (95%CI 14.45, 72.38), p=0.003]、Clavien–Dindo ≥ III级并发症发生率[OR 1.87, (95%CI 1.13, 3.11), p=0.02]及死亡率[OR 2.61, (95%CI 1.20, 5.68), p=0.02]。值得注意的是，作为次要终点指标，两组在平均淋巴结清扫数目及R0切除率方面未见差异。(4) 结论：MIPD在老年患者中相对安全；然而，老年患者的主要并发症发生率、肺部并发症发生率及死亡率略高，而这类患者可能正是最能从微创手术中获益的群体。
Minimally Invasive Pancreaticoduodenectomy in Elderly versus Younger Patients: A Meta-Analysis
肿瘤(癌症)患者之家