Robotic distal pancreatectomy: greatest benefit for the frail?

Pancreatic cancer is more common in the elderly who represent a rapidly growing part of the population. Elderly patients are a heterogeneous group and vary greatly in terms of physiologic reserves. Frailty represents a state of reduced capacity to compensate against stressors such as surgery or chemotherapy. Frailty assessment before pancreatectomy or initiation of systemic therapy correlates strongly with postoperative adverse effects, treatment related toxicity and patient outcomes. Robotic assisted surgery represents a lesser physiologic insult compared to open surgery. Most frail patients can better compensate to the stress of a robotic procedure. Robotic distal pancreatectomy is associated with a faster recovery and a reduction in major morbidity proportionate to the degree of frailty. This benefit is lost in the event of conversion to traditional open surgery. In this article we summarize current concepts on the relationship of frailty and surgical outcomes, the importance of frailty assessment for pancreatic cancer patients undergoing surgery and the benefits of robotic-assisted pancreatectomy for the frail.