Giovanni Domenico Tebala, Fanny Massimi, Francesca Duro, Ahmed Abdelsamad, Stefano Avenia, Gian Luca Baiocchi, Andrea Barberis, Chafik Bouzid, Antoine Castel, Graziano Ceccarelli, Andrea Celotti, Nicola Cillara, Nicola Cinardi, Roberto Cirocchi, Maria Conticchio, Giuseppe Currò, Antonella Delvecchio, Raffaele Vincenzo De Rosa, Jacopo Desiderio, Antonio Di Cintio, Fabio Francesco Di Mola, Domenico Di Nardo, Alessia Fassari, Alessandro Gemini, Carlos Augusto Gomes, Gian Luca Grazi, Giuseppe Margani, Alessandro Mazzotta, Luca Morelli, Andrea Muratore, Fabrice Muscari, Edoardo Maria Muttillo, Alberto Patriti, Gaetano Piccolo, Luca Properzi, Alessandro Puzziello, Lucia Romano, Edoardo Rosso, Sara Saeidi, Andrea Sagnotta, Edoardo Saladino, Marcello Giuseppe Spampinato, Laurent Sulpice, Nádia Tenreiro, Paolo Ubiali, Riccardo Memeo, DoS-RAP Collaborative. Ann Hepatobiliary Pancreat Surg -0001;0:. https://doi.org/10.14701/ahbps.26-007

Background: With population aging and the increasing incidence of pancreatic and periampullary malignancies, more elderly patients are being considered for pancreaticoduodenectomy (PD). Although robotic pancreaticoduodenectomy (RPD) is steadily adopted, evidence regarding its safety in patients aged ≥ 75 years remains limited, particularly in centers with restricted access to robotic platforms. Materials and Methods: We conducted a retrospective single-center study including patients who underwent PD between January 2019 and September 2025. Outcomes after RPD were compared between patients aged < 75 and ≥75 years. In addition, elderly patients undergoing RPD were compared with elderly patients undergoing open pancreaticoduodenectomy (OPD) using 1:2 propensity score matching. The primary endpoint was major postoperative morbidity (Clavien–Dindo grade ≥ III). Results: Among 525 PDs, 130 (25%) were performed robotically, including 29 patients aged ≥ 75 years. Within the RPD cohort, age ≥ 75 years was not associated with an increased risk of major complications compared with younger patients (OR 0.68, 95% CI 0.23–1.76; p = 0.45), nor with higher 90-day mortality. In the propensity score-matched elderly cohort, major morbidity was similar between RPD and OPD (10% vs. 7%; p = 0.68). RPD was associated with a significantly lower 30-day readmission rate, despite a higher incidence of delayed gastric emptying, mainly driven by mild (grade A) cases. Conclusions: RPD appears to be safe in carefully selected patients aged ≥ 75 years, with morbidity and mortality comparable to those observed in younger RPD patients and in elderly patients undergoing open surgery. These findings support the selective use of RPD in elderly patients, even in centers with limited access to robotic platforms.