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

• 22 patients (16.7%) over 65 experienced loss of independence after surgery, compared to none under 65.
• Key risk factors include age ≥80 years, sarcopenia, and open surgical approach.

Identifying these factors can enhance patient selection and surgical decision-making.

• A loss of independence score was developed, showing a strong correlation with the incidence of loss of independence (p < 0.001).