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Objectives <p>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.</p> Methods <p>We retrospectively analyzed 215 patients underwent PD between August 2017 and April 2024. Patients were classified into young (&lt; 65&#xa0;years) and elderly groups (≥ 65&#xa0;years). Using univariate and multivariate analyses, we assessed risk factors of LOI after PD.</p> Results <p>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&#xa0;years (<i>P</i> &lt; 0.001), sarcopenia (<i>P</i> &lt; 0.001), open surgery (<i>P</i> = 0.013), and malignant disease (<i>P</i> = 0.009) were the risk factors of LOI. Multivariate analysis identified age ≥ 80&#xa0;years (<i>P</i> &lt; 0.001), sarcopenia (<i>P</i> &lt; 0.001), and open surgery (<i>P</i> = 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 (<i>P</i> &lt; 0.001).</p> Conclusions <p>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.</p> Graphical abstract <p></p>

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

  • 期刊论文

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  • 发表日期：

    2025年12月29日

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  • Atsushi Nara,
  • Hiroki Ueda,
  • Yukue Shimizu,
  • Daisuke Asano,
  • Yoshiya Ishikawa,
  • Keiichi Akahoshi,
  • Eriko Katsuta,
  • Junko Torigoe,
  • Daisuke Ban

摘要

Objectives

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.

Methods

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.

Results

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).

Conclusions

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.

Graphical abstract