Robot-assisted Middle Pancreatectomy For Elderly People: Postoperative Fistula May Be No Longer The Obstacle

Background To evaluate the indications,safety,feasibility,short and long-term outcomes for elderly patients who underwent robot-assisted middle pancreatectomy(MP).Methods Ten patients(≥60 years)underwent robot-assisted middle panceatectomis from 2012 to 2015.The perioperative data,including tumor size,operation time,postoperative pancreatic fistula(POPF),postoperative morbidity and other parameters were analyzed and so was the follow-up information.Results The mean age of patients was 64.30 y.The average tumor size was 2.61 cm.Ten cases were all benign or low-grade malignant lesions.The mean operating time was 175.00 min.The mean bloodloss was 113.00 ml with no blood transfusion.Postoperative fistulas happened in 5 patients and there were 2 and 3 Grade A and B fistulas,respectively.There were 3 patients who underwent postoperative complications,including two Grade 1 or 2 complications and one Grade 3 complication.No reoperation and postoperative mortality happened.The mean hospital stay was 19.91 d.After a median follow-up of 30.5 months,new onset of diabetes mellitus happened in one patient and nobody suffered from deterioration of previous diagnosed diabetes and exocrine insufficiency,and no tumor recurrence happened.Conclusion Robot-assisted middle pancreatectomy was safe and feasible for elderly people.It had low risk of exocrine or endocrine dysfunction and benefited for long-term outcomes of patients.Incidence of POPF was relatively high but we could prevent it from resulting in bad outcomes by scientific perioperative care and systemic treatment.