Evaluation of clinical prognostic variables on short-term outcome for colorectal cancer surgery: An overview and minimum dataset

Sarcopenia as a Prognostic Factor for the Outcomes of Surgical Treatment of Colorectal Carcinoma

Background/Objectives: Sarcopenia, defined as the progressive loss of muscle mass and function, is increasingly associated with worse outcomes in the surgical treatment of colorectal cancer (CRC). This paper focuses on analyzing the impact of sarcopenia as a prognostic factor on postoperative outcomes in CRC patients. The aim of the study is to identify the main factors influencing postoperative results. This will be accomplished via bibliometric analysis and highlighting the significance of muscle condition in the preoperative assessment of patients. Methods: The methodological approach involves analyzing bibliographic data from relevant scientific databases focused on sarcopenia and oncological surgery. The study employs a quantitative analysis of citations and collaborations among authors and institutions. The focus will be on research publications from 2013, when we first identified references to sarcopenia in the examined context. Results: The results show that sarcopenia significantly increases the risk of postoperative morbidity and mortality in CRC patients. Network analysis and keyword mapping reveal dominant research topics such as muscle condition, mortality, and postoperative complications. Meanwhile, we identify the need for standardized diagnostic methods for sarcopenia and their integration into clinical practice to improve predictive models and clinical approaches. Conclusions: These findings underscore the importance of interdisciplinary collaboration, preoperative assessment of muscle condition, and the implementation of standardized approaches to improve clinical outcomes for patients.

Preoperative frailty and postoperative complications after non-cardiac surgery: a systematic review

OBJECTIVE

Many tools have been used to assess frailty in the perioperative setting. However, no single scale has been shown to be the most effective in predicting postoperative complications. We evaluated the relationship between several frailty scales and the occurrence of complications following different non-cardiac surgeries.

METHODS

This systematic review was registered in PROSPERO (CRD42023473401). The search strategy included PubMed, Google Scholar, and Embase, covering manuscripts published from January 2000 to July 2023. We included prospective and retrospective studies that evaluated frailty using specific scales and tracked patients postoperatively. Studies on cardiac, neurosurgical, and thoracic surgery were excluded because of the impact of underlying diseases on patients' functional status. Narrative reviews, conference abstracts, and articles lacking a comprehensive definition of frailty were excluded.

RESULTS

Of the 2204 articles identified, 145 were included in the review: 7 on non-cardiac surgery, 36 on general and digestive surgery, 19 on urology, 22 on vascular surgery, 36 on spinal surgery, and 25 on orthopedic/trauma surgery. The reviewed manuscripts confirmed that various frailty scales had been used to predict postoperative complications, mortality, and hospital stay across these surgical disciplines.

CONCLUSION

Despite differences among surgical populations, preoperative frailty assessment consistently predicts postoperative outcomes in non-cardiac surgeries.

How can we approach preoperative frailty and related factors in patients with cancer? A scoping review

AIM

To identify factors related to preoperative frailty in patients with cancer and map the tools that measure frailty.

DESIGN

A Scoping review.

METHODS

This scoping review based on Arksey and O'Malley's framework. Articles from CINAHL, PubMed, EMBASE, and PsycINFO databases published between January 2011 and April 2021. The searched keywords were concepts related to 'cancer', 'frailty' and 'measurement'.

RESULTS

While 728 records were initially identified, 24 studies were eventually selected. Research on frailty was actively conducted between 2020 and 2021. Factors related to preoperative frailty were age (22.9%), sex (11.4%), body mass index (11.4%) and physical status indicators (54.3%). The most common result of preoperative frailty was postoperative complications (35.0%). 24 instruments were used to measure frailty.

IMPLICATIONS FOR PATIENT CARE

Selecting an appropriate preoperative frailty screening tool can help improve patient postoperative treatment outcomes.

IMPACT

There are many instruments for assessing preoperative frailty, each evaluating a multi-dimensional feature. We identified the frailty screening tools used today, organized the factors that affect frailty, and explored the impact of frailty. Identifying and organizing frailty measurement tools will enable appropriate evaluation.

REPORTING METHOD

PRISMA-ScR.

PATIENT CONTRIBUTION

No patient or public contribution.

The relationship between the modified frailty index score (mFI-5), malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer

BACKGROUND

While the current literature suggests an association with frailty and clinical outcomes in patients undergoing surgery for colorectal cancer (CRC), the basis of this relationship is unclear.

AIM

Examine the relationship between frailty, malnutrition, body composition, systemic inflammation and short-term clinical outcomes in patients undergoing surgery for colorectal cancer.

METHODS

Consecutive patients who underwent potentially curative resection for colorectal cancer, between April 2008 and April 2018, were identified from a prospectively maintained database. Frailty was defined using the modified five-item frailty index (mFI-5). Body composition measures included CT-derived skeletal muscle index (SMI) and density (SMD). Systemic inflammatory status was determined using Systemic Inflammatory Grade (SIG). Outcomes of interest were the incidence of post-operative complications and thirty-day mortality. Associations between categorical variables were examined using χ² test and binary logistics regression analysis.

RESULTS

1002 patients met the inclusion criteria. 28% (n = 221) scored 2 or more on the mFI-5. 39% (n = 388) of patients had a post-operative complication (Clavien-Dindo I-IV) and 1% (n = 11) died within thirty days of surgery. On univariate analysis, mFI-5 frailty score, was significantly associated with advanced age (p < 0.001), colonic tumours (p < 0.001), reduced use of neo-adjuvant chemotherapy (p < 0.05), higher BMI (p < 0.05), low SMD (p < 0.001), elevated NLR (p < 0.05), elevated mGPS (p < 0.05), elevated SIG (p < 0.05), incidence of post-operative complications (p < 0.001) and thirty-day mortality (p < 0.05). On multivariate analysis, male sex (p < 0.05), elevated SIG (p < 0.05) and mFI-5 score (p < 0.01) remained significantly associated with the incidence of post-operative complications. mFI-5 frailty was found to remain significantly associated with the incidence post-operative complications in patients who were SIG 0 (p < 0.05).

CONCLUSION

mFI-5 frailty score was found to be significantly associated with age, systemic inflammation and post-operative outcomes in patients undergoing potentially curative resections for CRC. Incorporation of an assessment of systemic inflammatory status in future frailty screening tools may improve their prognostic value.