The role of older age and obesity in minimally invasive and open pancreatic surgery: A systematic review and meta-analysis

Abstract Background/objectives The aim of this study was to assess the impact of older age (>70 years) and obesity (BMI ≥30) on surgical outcomes of minimally invasive pancreatic resections (MIPR). Subsequently, open pancreatic resections or MIPR were compared for elderly and/or obese patients. Methods A systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on MIPR (IG-MIPR). Study quality assessment was according to The Scottish Intercollegiate Guidelines Network (SIGN). A meta-analysis was performed to assess the impact of MIPR or open pancreatic resections in elderly patients. Results After screening 682 studies, 13 observational studies with 4216 patients were included. Elderly patients undergoing laparoscopic distal pancreatectomy (LDP) had less blood loss (113 mL, p  Conclusion The current available limited evidence does not suggest that MIPR is contraindicated in elderly or obese patients. Additionally, outcomes in MIPR are equal or more beneficial compared to the open approach when applied in these patient groups.