# Minimally invasive surgery reduces the risk of loss of independence after pancreatoduodenectomy in elderly patients

## TL;DR

Minimally invasive surgery lowers the risk of losing independence after pancreatoduodenectomy in elderly patients.

## Contribution

This is the first study to identify risk factors for loss of independence after pancreatoduodenectomy in elderly patients.

## Key findings

- Elderly patients undergoing open surgery had a higher risk of losing independence.
- Age ≥80 years and sarcopenia were significant independent risk factors for loss of independence.
- A LOI score based on these factors correlated strongly with the incidence of loss of independence.

## Abstract

Pancreatoduodenectomy (PD) is a highly invasive surgery that raises concerns about postoperative loss of independence (LOI), a critical outcome defined as a decline in activities of daily living (ADL). LOI reflects a significant shift in functional status, often requiring additional care such as rehabilitation or home-based healthcare. While reducing complications and mortality is prioritized, maintaining a preoperative lifestyle remains underexplored. Therefore, this study aimed to elucidate the risk factors of LOI after PD.

We retrospectively analyzed 215 patients underwent PD between August 2017 and April 2024. Patients were classified into young (< 65 years) and elderly groups (≥ 65 years). Using univariate and multivariate analyses, we assessed risk factors of LOI after PD.

There was no incidence of LOI in the young group, whereas 22 patients (16.7%) developed LOI in the elderly group. Univariate analysis revealed that age ≥ 80 years (P < 0.001), sarcopenia (P < 0.001), open surgery (P = 0.013), and malignant disease (P = 0.009) were the risk factors of LOI. Multivariate analysis identified age ≥ 80 years (P < 0.001), sarcopenia (P < 0.001), and open surgery (P = 0.040) as the independent risk factors of LOI in the elderly group. Using these three factors, we established LOI score. This LOI score significantly correlated with the incidence of LOI (P < 0.001).

This is the first study to identify the risk factors of LOI after PD. It may help the decision-making regarding MIS surgery with other risk factors in clinical practice.

The online version contains supplementary material available at 10.1007/s00464-025-12518-2.