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.
Keywords: Elderly; Loss of independence; Minimally invasive surgery; Pancreatoduodenectomy; Sarcopenia.
© 2025. The Author(s).