Minimally invasive surgery in the elderly population in Korea: temporal trends across major abdominal surgeries

Korea's rapid transition toward a super-aged society has markedly increased the demand for major abdominal surgery in older adults. Although minimally invasive surgery (MIS) provides perioperative advantages, including reduced surgical trauma, lower blood loss, and accelerated postoperative recovery, it also introduces pathophysiological challenges that require preoperative evaluation and risk stratification. This presidential lecture summarizes trends in geriatric surgery in Korea, highlights perioperative considerations for elderly patients undergoing MIS, and presents longitudinal outcomes from Severance Hospital. Surgical trends and perioperative outcomes were evaluated for major abdominal procedures, including gastrectomy, colectomy, major hepatectomy, and pancreatoduodenectomy (PD), in patients aged ≥70 years. Analyses demonstrated a progressive transition from open surgery toward minimally invasive approaches. Laparoscopic and robotic techniques have become the predominant approaches for gastrectomy and colectomy, including in octogenarians, while MIS adoption for complex procedures, such as major hepatectomy and PD, has also expanded substantially. Comparative analyses within this elderly cohort demonstrated that MIS was associated with superior perioperative outcomes compared with open surgery, including significantly reduced estimated blood loss, shorter hospitalization, and lower rates of clinically significant complications, such as postoperative pancreatic fistula, without compromising procedural safety. Advances in surgical technology and accumulated institutional expertise have established MIS as a feasible, standardized approach for major abdominal surgery in older adults. Integrating comprehensive preoperative assessment, particularly frailty screening, with the selective application of MIS may represent the optimal strategy for reducing operative risk and promoting postoperative functional recovery in geriatric surgical care.