Impact of Surgical Approach on Postoperative Independence in Elderly Patients Undergoing Pancreatoduodenectomy

Minimally invasive pancreatoduodenectomy demonstrated a lower risk of postoperative loss of independence (LOI) in older adults than open surgery in a single-center cohort — a finding that reorients perioperative planning toward functional preservation.

In this retrospective cohort, 215 patients underwent pancreatoduodenectomy; 132 were aged ≥65 years and 22 (16.7%) of those developed LOI. Among the elderly, 24 had minimally invasive procedures and none developed LOI, compared with 20.4% LOI after open surgery (P = 0.013). Multivariable adjustment for clinical covariates indicated open surgery remained independently associated with LOI (P = 0.040). The report did not supply an adjusted effect estimate or 95% CI. Investigators also proposed a three-point LOI score (age ≥80 years, sarcopenia, open surgery) with an AUC of 0.873, suggesting strong discriminative performance. In practical terms, shifting eligible elderly cases from open to minimally invasive approaches corresponded to an absolute LOI reduction on the order of 20 percentage points in this cohort.

On multivariable analysis, age ≥80 years, sarcopenia, and open surgery were independent predictors of postoperative LOI. Sarcopenia—objectively measured preoperatively—indicates reduced muscle mass and strength, lower physiologic reserve, and greater vulnerability to complications and prolonged rehabilitation. Routine preoperative assessment for sarcopenia can refine risk stratification and guide perioperative planning to mitigate LOI.

A less invasive operative approach reduces physiologic insult, lowers postoperative pain, and enables earlier mobilization—mechanisms linked to preserved function. The cohort showed fewer discharges to higher-level care and faster return toward baseline activities among minimally invasive cases; however, these are observational associations that may reflect case selection and center experience rather than direct causation. Patients with modifiable frailty markers or borderline independence who are technically suitable for minimally invasive procedures may realize the largest independence gains.

Integrating prehabilitation (nutrition and targeted strength training), routine sarcopenia screening, and multidisciplinary discharge planning alongside selective use of minimally invasive techniques offers a practical pathway to prioritize independence. Benefits will depend on surgeon and center experience, and the retrospective design limits definitive causal inference. Prospective validation and implementation of care pathways that include functional outcomes as primary endpoints are warranted.