Chirurgia del tumore del retto nel paziente grande anziano: analisi dell'autonomia post-operatoria e outcomes chirurgici

Background: In elderly patients undergoing rectal cancer surgery, chronological age alone is an inadequae determinant of surgical risk and postoperative recovery. Functional reserve and frailty critically influence early postoperative outcomes, yet objective measures of functional autonomy are rarely integrated into surgical decision-making. The Karnofsky Performance Status (KPS) provides a simple assessment of patient independence, but data on its prognostic value for early postoperative functional decline in very elderly patients are limited. Methods: We conducted a retrospective cohort study including patients aged ≥70 years undergoing curative-intent rectal cancer surgery between 2010 and 2024. Patients were stratified into 70–79 years and ≥80 years. Functional autonomy was assessed using the KPS preoperatively and 30 days postoperatively. Postoperative functional dependence was defined as KPS ≤50, indicating loss of independence in activities of daily living. Surgical, oncologic, and survival outcomes were analyzed, and predictors of early functional deterioration were identified using multivariable models. Results: Among 303 patients, those aged ≥80 years exhibited greater baseline frailty and lower use of neoadjuvant and adjuvant therapies, despite comparable tumor stage. Surgical morbidity and recurrence-free survival did not differ by age. However, very elderly patients more frequently developed postoperative functional dependence (13% vs 3%, p=0.02), which was strongly associated with worse overall survival. In functionally fit patients, minimally invasive surgery was independently protective, whereas ileostomy creation significantly increased the risk of early functional decline. Conclusions: Early postoperative functional decline assessed by the KPS identifies frail elderly patients at high risk of poor outcomes after rectal cancer surgery, regardless of cronological age. Integrating functional assessment and dedicated perioperative pathways may help preserve autonomy and optimize surgical outcomes in this population.