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Background <p>Activities of daily living (ADL) are an important outcome of surgery for elderly patients. As life expectancy increases, interest in minimally invasive surgery (MIS) is increasing. However, there is limited evidence regarding the effect of MIS on ADL, especially in the very elderly patients (≥ 80&#xa0;years).</p> Methods <p>A total of 1009 consecutive patients (80–99&#xa0;years) undergoing elective surgery for gastrointestinal and hepatobiliary-pancreatic tumors between 2010 and 2025 were enrolled. Propensity score matching (PSM, 1:1) was performed in 869 patients after excluding those with benign tumors or missing data. A comparison was made between MIS (laparoscopic/robotic, <i>n</i> = 284) and open surgery (<i>n</i> = 284). The primary outcome was postoperative ADL decline. Severe postoperative ADL decline was defined as a decline of ≥ 30 points in the Barthel Index total score.</p> Results <p>Postoperative ADL decline was observed in 128 patients (14.7%) in the entire cohort. After PSM, postoperative ADL decline occurred in 17.3% and 19.4% of patients in the open and MIS groups, respectively (<i>P</i> = 0.59). Severe postoperative ADL decline was lower in the MIS than in the open groups (5.7% vs. 9.5%, <i>P</i> = 0.11). The 90-day readmission rate was also lower in the MIS groups (16.6% vs. 22.3%, <i>P</i> = 0.11). Intraoperative blood loss, ICU and hospital length of stay, and severe postoperative complications were significantly better in the MIS group. In high-risk or frail subgroups, such as those with poor performance status, care needs, and severe complications, MIS consistently demonstrated lower rates of severe postoperative ADL decline compared with open surgery.</p> Conclusions <p>Compared with open surgery, MIS reduced the incidence of severe postoperative ADL decline and 90-day readmission. Subgroup analysis indicated that this trend was strongest in high-risk or frail patients. These results suggest that MIS may help maintain postoperative independence and prevent functional frailty in the very elderly patients.</p> Graphical abstract <p></p>

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Effect of minimally invasive surgery on activities of daily living in elderly patients aged ≥ 80 years with gastrointestinal and hepatobiliary-pancreatic cancers: a propensity score-matched analysis

  • 期刊论文

  • 发表日期：

    2026年3月9日

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  • Kei Harada,
  • Keiji Nagata,
  • Toshimitsu Maki,
  • Yusuke Uemoto,
  • Toshifumi Watanabe,
  • Ippei Yamana,
  • Yuichiro Kawamura,
  • Takahisa Fujikawa

摘要

Background

Activities of daily living (ADL) are an important outcome of surgery for elderly patients. As life expectancy increases, interest in minimally invasive surgery (MIS) is increasing. However, there is limited evidence regarding the effect of MIS on ADL, especially in the very elderly patients (≥ 80 years).

Methods

A total of 1009 consecutive patients (80–99 years) undergoing elective surgery for gastrointestinal and hepatobiliary-pancreatic tumors between 2010 and 2025 were enrolled. Propensity score matching (PSM, 1:1) was performed in 869 patients after excluding those with benign tumors or missing data. A comparison was made between MIS (laparoscopic/robotic, n = 284) and open surgery (n = 284). The primary outcome was postoperative ADL decline. Severe postoperative ADL decline was defined as a decline of ≥ 30 points in the Barthel Index total score.

Results

Postoperative ADL decline was observed in 128 patients (14.7%) in the entire cohort. After PSM, postoperative ADL decline occurred in 17.3% and 19.4% of patients in the open and MIS groups, respectively (P = 0.59). Severe postoperative ADL decline was lower in the MIS than in the open groups (5.7% vs. 9.5%, P = 0.11). The 90-day readmission rate was also lower in the MIS groups (16.6% vs. 22.3%, P = 0.11). Intraoperative blood loss, ICU and hospital length of stay, and severe postoperative complications were significantly better in the MIS group. In high-risk or frail subgroups, such as those with poor performance status, care needs, and severe complications, MIS consistently demonstrated lower rates of severe postoperative ADL decline compared with open surgery.

Conclusions

Compared with open surgery, MIS reduced the incidence of severe postoperative ADL decline and 90-day readmission. Subgroup analysis indicated that this trend was strongest in high-risk or frail patients. These results suggest that MIS may help maintain postoperative independence and prevent functional frailty in the very elderly patients.

Graphical abstract