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Evaluating the Role of Surgical Approach in Frail Patients Undergoing Distal Pancreatectomy for Intraductal Papillary Mucinous Neoplasms
Journal article   Peer reviewed

Evaluating the Role of Surgical Approach in Frail Patients Undergoing Distal Pancreatectomy for Intraductal Papillary Mucinous Neoplasms

Ethan Angle, Amir Ebadinejad, Raegen Abbey, Brian Longbottom and Hassan Aziz
Journal of gastrointestinal surgery, 102401
03/19/2026
DOI: 10.1016/j.gassur.2026.102401
PMID: 41864324

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Abstract

Minimally invasive surgery has been associated with reduced postoperative morbidity compared to traditional open approaches, suggesting that it may be advantageous for frail patients. However, its effect on frail individuals with intraductal papillary mucinous neoplasms (IPMNs) undergoing distal pancreatectomy (DP) remains unclear. This study evaluated the association between surgical approach and postoperative outcomes in the context of patient frailty. Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 1,120 patients with non-malignant IPMN who underwent DP between 2019 and 2023. Frailty was defined as a modified frailty index (mFI) of ≥2, calculated using five variables: diabetes, hypertension, functional dependency, COPD, and CHF. Patients were categorized according to their frailty status and surgical approach (MIS vs. open). Postoperative outcomes, including complications, major complications, readmission, reoperation, and mortality, were compared between groups using univariate and multivariate analyses. Frail patients comprised 27.7% of the cohort (n=310) and were more likely to experience complications (35.1% vs 28.4%, p=0.042) and longer hospital stay (mean 5.9 versus 5.3 days, p=0.009). In the overall cohort, frailty independently predicted higher odds of complications (OR 1.44, 95% CI: 1.05-1.97) and readmission (OR 1.68, 95% CI: 1.16-2.45), whereas male sex and older age were associated with increased mortality. MIS was not associated with reduced odds of complications, readmission, reoperation, or mortality in the frail or non-frail populations. Frailty is an independent predictor of complications and readmission after DP for IPMN. However, MIS does not appear to confer benefits over open surgery in frail or non-frail patients.
 frailty distal pancreatectomy intraductal papillary mucinous neoplasm surgical outcomes surgical approach

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