Propensity score-matching analysis comparing minimally invasive and open distal pancreatectomy in elderly patients and application of the modified frailty index

Purpose: To compare the postoperative course of elderly patients (≥70 years) submitted to minimally-invasive(MIDP) vs. open distal pancreatectomy(ODP), and evaluate if modified Frailty Index (mFI) predicts surgical course. Methods: Data 204 aged ≥70 who underwent DP at single institution between March 2011 December 2019 were retrospectively retrieved. Of these patients, 42 MIDP propensity-score matched, according baseline characteristics, with received ODP. Demographics, intraoperative, outcomes compared. According mFI, whole cohort patients(n=204) was stratified into three groups: non-frail(mFI=0), mildly frail (mFI=1/2), or severely frail(mFI=3), mFI correlated outcomes. Results: The complications considered homogenously two groups, no statistically significant differences ODP for each them. severity increased as did among groups reference any complication (p=0.022), abdominal collection(p=0.014), pulmonary complication(p=0.001), confusion (p=0.047), Clavien-Dindo ≥ 3 events (p=0.036), length stay (p=0.018). Conclusion: Elderly can be safely MIDP. identifies more prone develop non-surgical complications. Further prospective multi-center studies are needed confirm findings.