Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty

Maeda, Hiromichi; Takahashi, Michiko; Seo, Satoru; Hanazaki, Kazuhiro

doi:10.3390/jcm12155041

Cited by 4 publications

(2 citation statements)

References 77 publications

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Section: Discussionmentioning

confidence: 99%

“…As discussed above, a higher rate of complications, especially anastomotic leakage, is seen in male and elderly patients [ 12 , 13 , 15 ]. We also know that mortality rates are higher in frail patient groups [ 15 ]. As a result of our study, we obtained clues that the possibility of preoperative sarcopenia is high in male and elderly patients, who already have a higher risk of complications and mortality; thus, monitoring those patients more closely and acting proactively in their treatment will be useful.…”

Section: Discussionmentioning

confidence: 99%

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Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates

Rasa,

Erdemir

2023

Cureus

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Background: Evidence about the importance of sarcopenia in patients operated on for gastrointestinal cancers and that it may have both early and long-term impacts is expanding. In our study, we aimed to evaluate the impact of sarcopenia on the outcomes of the patients we operated on for left colon and rectum cancer. Methods: We retrospectively evaluated the electronic records of 38 patients operated on for left colon and rectal cancer between 2010 and 2020, and demographic variables, clinical stages, laboratory tests, body mass index (BMI), psoas muscle index (PMI), pathological stages, and Dindo Clavien complication scores were interpreted. We also assigned our patients into two groups according to their preoperative PMI values. We compared the first group of 12 patients with preoperative sarcopenia with the second group of 26 patients without preoperative sarcopenia. Results: Of the 38 patients who underwent curative surgery for left colon and rectal cancer, 20 were female and 18 were male. The median age of the group was 59.9 years. The most common tumour localization was in the rectosigmoid region in 17 patients, and the tumour in 6 patients was in the left colon. Therapy had been initiated with neoadjuvant treatment in 19 patients. At the preoperative evaluation, sarcopenia was present in 12 patients. Thirty-four patients underwent robot-assisted surgery. Postoperative pathologies were reported as stage 3 in 15 patients. Complications were reported in 17 patients, and nine were minor (Dindo-Clavien score < 3), but in eight patients, they were moderate to severe (Dindo-Clavien score ≥ 3). When the first group, 12 patients with preoperative sarcopenia, and the second group, 26 patients without preoperative sarcopenia, were compared, the patients with sarcopenia were found to be older (p=0.001), and male patients were in the majority (p=0.017). The postoperative follow-up of 12 patients with preoperative sarcopenia revealed that 7 (58.8%) had complications. Complications were observed in 10 (38.4%) patients in the second group. When the two groups were compared, the risk of developing complications was significantly higher in the sarcopenia group (p=0.016). Only one patient in the first group had moderate to severe complications, but seven patients without sarcopenia had moderate to severe complications. Conclusion: Our study revealed that many patients we have operated on for left colon and rectal cancer have preoperative sarcopenia for which we should care. The sarcopenia rate was higher in males and elderly patients, and the risk of overall postoperative complications increased significantly in patients with preoperative sarcopenia. In consequence, the results of our study provide evidence that preoperative sarcopenia status is an important parameter to determine the risk status of the patient, and patients with preoperative sarcopenia should be monitored more closely. Thus, we may be able to diagnose and intervene early in the complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates

Rasa,

Erdemir

2023

Cureus

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Impacts of COVID‐19 pandemic on short‐term outcomes of low anterior resection performed in hospitals with different surgical volumes

Maeda,

Endo,

Seishima

et al. 2024

Annals of Gastroent Surgery

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AimTo evaluate the impact of the coronavirus disease (COVID‐19) pandemic on short‐term outcomes of low anterior resection (LAR) across hospitals classified by surgical volume.MethodsData of patients who underwent elective LAR for rectal cancer between 2018 and 2022 were obtained from the National Clinical Database of Japan. Hospitals were categorized into high‐, medium‐, and low‐volume groups. Each group was constituted to represent approximately one‐third of all surgeries performed between 2018 and 2019. The standardized morbidity/mortality ratios (SMRs) of Clavien–Dindo grade ≥3 (CD ≥ 3) complications were the primary endpoint. The secondary endpoints included anastomotic leakage, pneumonia, and surgical mortality.ResultsThis study analyzed 91 800 cases of elective LAR, with 10.5% experiencing CD ≥ 3 complications, 8.8% anastomotic leakage, 0.9% pneumonia, and 0.5% surgical mortality. Despite COVID‐19, SMRs of CD ≥ 3 complications decreased from 2018 to 2022 across all groups. However, increases in the rates and SMRs of CD ≥ 3 complications were observed in low‐volume hospitals around mid‐2020, followed by a decline. Anastomotic leakage showed similar trends. The rates and SMRs of pneumonia and surgical mortality remained unchanged. Notably, anastomotic leakage rates were 7.6%, 8.9%, and 10.0% in high‐, medium‐, and low‐volume hospitals, respectively, indicating superior outcomes in high‐volume hospitals.ConclusionEarly COVID‐19 waves may have disproportionately affected low‐volume hospitals. However, the decline in SMRs of CD ≥ 3 complications from 2018 to 2022 across all three groups suggests the robustness and resilience of surgical services for rectal cancer in Japan. The potential disparity in short‐term outcomes among hospitals is a new concern.

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Comment on Miao et al. (2024) ‘A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors’

Zheng,

2024

International Journal of Nursing Studies

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Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty

Cited by 4 publications

References 77 publications

Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates

Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates

Impacts of COVID‐19 pandemic on short‐term outcomes of low anterior resection performed in hospitals with different surgical volumes

Comment on Miao et al. (2024) ‘A dynamic online nomogram for predicting the heterogeneity trajectories of frailty among elderly gastric cancer survivors’

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