The role of laparoscopic distal pancreatectomy in elderly patients

INTRODUCTION: Minimally invasive surgery has gained wide acceptance in many institutions. Complex surgery such as pancreatic resections delayed its diffusion due to high rate postoperative complications and technical aspects, while for pancreaticoduodenctomy the role of a minimally invasive approach is still on debate. Laparoscopic distal pancreatectomy may be considered a safe procedure and a valid alternative in selected cases. The operating time, learning curve and the costs represent major drawbacks for the laparoscopic approach. Elderly patients (>70 years of age) are generally considered to be at higher risk for developing complications after pancreatic surgery due to compromised physiological reserve and presence of multiple comorbidities. Our aim was to make a review about the role of laparoscopic distal pancreatectomy (LDP) in the elderly population. EVIDENCE ACQUISITION: A systematic search of the scientific literature was performed using PubMed, EMBASE, online journals, and the Internet for all publications on LDP and open distal pancreatectomy (ODP) in old age patients.All selected articles were reviewed and analyzed. We found 393 abstract that were reviewed. We considered all type of publications. EVIDENCE SYNTHESIS: Laparoscopic pancreatic resections are considered more difficult due to the retroperitoneal organ location and by the presence of surrounding large vessels and other crucial structures. Therefore, an adequate learning curve is needed. Beyond these remarks, in many institutions, LDP is a standard approach in patients with lesions in the body and tail of the pancreas. The most evident advantage of LDP is the shorter length of stay. Age alone should not be considered as an absolute contraindication for LDP. Obviously, it is still too early to assess oncological outcomes, but the R0 resection rate, the number of harvested lymph nodes, and the overall survival rate are superimposable to ODP. CONCLUSIONS: LDP is safe and feasible if compared to ODP in selected elderly patients with body and tail pancreatic tumors. Less blood loss and shorter hospital stay are the most evident advantages of minimally invasive approach. Randomized controlled trials and high-volume centers prospective studies with long-term outcomes are necessary to consider laparoscopy a standard of care. Minimally invasive robotic surgery may represent an interesting alternative to laparoscopy especially for spleen-preserving procedures.