Impact of frailty on oncological outcomes in patients undergoing surgery for colorectal cancer – A systematic review and meta-analysis

Davey, Matthew G; Joyce, William

doi:10.1016/j.surge.2022.06.001

Cited by 9 publications

(1 citation statement)

References 47 publications

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“…As frailty is associated with delayed recovery from injury, long-term outcomes tend to worsen after surgery. In addition, several studies have demonstrated poor overall survival following surgery in patients with frailty [55,56], which has been related to a "natural" decline in function.…”

Section: Overall Survival and Disease-specific Outcomesmentioning

confidence: 99%

Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty

Maeda,

Takahashi,

Seo

et al. 2023

JCM

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Frailty is characterized by reduced physiological reserves across multiple systems. In patients with frailty, oncological surgery has been associated with a high rate of postoperative complications and worse overall survival. Further, given that cancer and frailty can co-exist in the same patient, cancer and cancer-related symptoms can rapidly accelerate the progression of baseline frailty, which we have termed “cancer frailty”. This distinction is clinically meaningful because the prioritization of interventions and the treatment outcomes may differ based on health conditions. Specifically, in patients with cancer frailty, improvements in frailty may be achieved via surgical removal of tumors, while prehabilitation may be less effective, which may in turn result in delayed treatment and cancer progression. In this review, we focused on challenges in the surgical treatment of non-metastatic colorectal cancers in patients with frailty, including those related to decision making, prehabilitation, and surgery. Potential recommendations for treating patients with cancer frailty are also discussed.

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Section: Overall Survival and Disease-specific Outcomesmentioning

confidence: 99%

Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty

Maeda,

Takahashi,

Seo

et al. 2023

JCM

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Prevalence and impact of frailty in patients undergoing colorectal cancer surgery: A systematic review and meta‐analysis based on modified frailty index

Xia,

Yin,

Mao

et al. 2024

Journal of Surgical Oncology

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Frailty has been linked to unfavorable postoperative outcomes in patients with colorectal cancer (CRC). However, the prevalence of frailty among CRC surgery patients and its association with mortality and postoperative complications, as evaluated by the modified frailty index (mFI), have not been thoroughly investigated and necessitate clarification. PubMed, Web of Science, Embase, and CBM databases were systematically searched for relevant studies (up to January 2024), and the pooled prevalence and odds ratio (OR) estimate were calculated. A total of 16 studies containing 245 747 patients undergoing CRC surgery were included. The prevalence of frailty among CRC surgery patients was 31% (95% confidence interval [CI] = 20%–42%; I2 = 100%, p < 0.001). In patients undergoing CRC surgery, frailty was associated with a higher incidence of postoperative complications (OR = 1.94; 95% CI = 1.47–2.56; I2 = 91.9%, p < 0.001), but it did not exhibit any significant correlation with the 30‐day mortality (OR = 5.17; 95% CI = 0.39–68.64; I2 = 94.4%, p < 0.001). Frailty is common in CRC surgery and exerts a significant negative impact on the postoperative outcomes. Future research could explore the potential of the mFI to facilitate a more streamlined and precise quantification of frailty, thereby establishing a refined understanding of its correlation with surgery prognosis.

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