Impact of preoperative frailty on the surgical and survival outcomes in older patients with solid cancer after elective abdominal surgery

Comparative value of frailty versus ECOG performance in preoperative risk assessment for elderly patients with gastric cancer

BACKGROUND

Radical gastrectomy with D2 lymphadenectomy reduces the postoperative recurrence in gastric cancer, but increases risk of complications, especially among elderly patients. This study aimed to assess the predictive value of frailty in determining postoperative complication risks in patients aged ≥80 years undergoing D2 gastrectomy.

METHODS

This prospective observational study enrolled 78 patients aged ≥80 years who underwent gastrectomy with D2 lymphadenectomy for gastric cancer between January 2020 and December 2021 ​at a medical center in Taiwan. Frailty was evaluated using the Comprehensive Geriatric Assessment (CGA) within one week before surgery.

OUTCOMES

Length of hospital stay (LOS), intensive care unit (ICU) stays, postoperative complications, and survival were analyzed and compared with the Eastern Cooperative Oncology Group (ECOG) performance status.

RESULTS

Among the 78 patients, ECOG performance scores were 0, 1, 2, and 3 in 47 ​%, 40 ​%, 12 ​%, and 1 ​% of patients, respectively; 19 patients (24 ​%) were classified as fit and 59 (76 ​%) as frail based on CGA. Frail patients had a significantly longer median LOS (20 days vs. 12 days, p ​= ​0.001), a higher ICU admission rate (46 ​% vs. 16 ​%, p ​= ​0.027), a higher incidence of any surgical complication (85 ​% vs. 47 ​%, p ​= ​0.001), and an increased rate of major surgical complications (Accordion grade 2 or higher) (24 ​% vs. 0 ​%, p ​= ​0.012) compared to fit patients. Although ECOG performance was associated with major complication rates, it did not significantly predict LOS, ICU admissions, or overall complication rates. Survival did not differ significantly between the frail and ECOG performance groups.

CONCLUSIONS

This study demonstrates that frailty is commonly observed in Taiwanese octogenarian patients and is a valuable predictor of postgastrectomy outcomes.

Integrating Frailty Assessment to Enhance Care in Cancer Patients with Borderline Eastern Cooperative Oncology Group Performance Status

BACKGROUND

The (ECOG) performance status (PS) is commonly used to evaluate the functional ability of patients undergoing antitumor therapy. An ECOG PS of 2, indicating patients capable of self-care but restricted strenuous activity, can complicate treatment decisions owing to concerns regarding treatment-related toxicity. We investigated whether frailty assessment could help discriminate treatment tolerance and survival outcomes in patients with an ECOG PS of 2.

METHODS

We prospectively included 45 consecutive patients, aged ≥65 years, with an ECOG PS of 2, and newly diagnosed solid cancer scheduled for chemotherapy. Frailty was assessed using an eight-indicator geriatric assessment. The primary outcome was overall survival (OS) based on frailty status; secondary outcomes included treatment tolerance and toxicity.

RESULTS

The median patient age was 73 years (range 65-94), and 71% had stage IV disease. Predominant frailty-related deficits were functional decline (96%), malnutrition (78%), and polypharmacy (51%). The median OS was 12.6 months (95% confidence interval [CI]: 6.8-18.4). Patients with 4-6 deficits had significantly lower OS than those with 1-3 deficits (9.9 months vs. 20.0 months, adjusted hazard ratio 2.51, 95% CI: 1.16-5.44, P = .020). Frailty significantly correlated with reduced 12-week chemotherapy competence (52% vs. 85%, adjusted odds ratio [OR] .14, 95% CI: .03-.70, P = .016) and enhanced risk of unexpected hospitalization (60% vs. 20%, adjusted OR 6.80, 95% CI: 1.64-28.1, P = .008).

CONCLUSION

Our findings highlight the multifaceted nature of patients with an ECOG PS of 2 and emphasize the importance of frailty assessment for treatment outcomes.

Association of preoperative cognitive frailty with postoperative complications in older patients under general anesthesia: a prospective cohort study

BACKGROUND

Cognitive frailty (CF) is characterized by the coexistence of physical frailty and cognitive impairment, and it is associated with adverse health outcomes. Older adults are particularly vulnerable to CF due to factors such as age-related brain changes and the presence of comorbidities.

OBJECTIVE

To investigate the effect of preoperative CF on postoperative complications in older patients.

METHODS

This prospective cohort study was conducted among 253 patients aged 60-85 years, who underwent elective orthopedic and abdominal surgery (with a postoperative hospital stay of ≥ 3 days) at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2023 to November 2023. CF was assessed using the Montreal Cognitive Assessment (MoCA) for the cognitive status and the Fried criteria for five frailty scales. Participants were split into four groups: Group A (neither frailty nor cognitive impairment), Group B (frailty without cognitive impairment), Group C (cognitive impairment without frailty), and Group D (cognitive frailty). The primary outcome was postoperative complications, while secondary outcomes included mobility disability, prolonged hospital stay (PLOS), re-operation and 90-day readmission.

RESULTS

The median age (interquartile range) of participants was 69 (65-73) years, of which 40.3% were male. The prevalence of CF was 17.8%. The incidence of postoperative complications was 18.2% in Group A, 50.0% in Group B, 37.4% in Group C, and 75.6% in Group D. Multivariate analysis revealed that, compared to the control group (without cognitive impairment or frailty), patients with CF had a significantly higher risk of postoperative complications (OR, 12.86; 95%CI, 4.23-39.08). "Patients with frailty without cognitive impairment" had an increased risk (OR, 6.53; 95%CI, 2.04-20.9), while "those with cognitive impairment without frailty" also showed a higher risk (OR, 3.46; 95%CI, 1.57-7.64).

CONCLUSIONS

Cognitive frailty is significantly associated with an increased risk of postoperative adverse outcomes in older patients undergoing orthopedic and abdominal surgeries with general anesthesia. It indicates that clinicians should pay much attention to these older adults with CF.