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High Risk, High Reward: Frailty in Colorectal Cancer Surgery is Associated with Worse Postoperative Outcomes but Equivalent Long-Term Oncologic Outcomes

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Frailty is a physiologic state that affects perioperative outcomes. Studies evaluating the impact of frailty on long-term oncologic outcomes are limited. This study evaluated perioperative and long-term oncologic outcomes for elderly patients undergoing colorectal surgery.

Methods

Patients older than 65 years at the time of colorectal resection between July 2011 and September 2020 at Roswell Park Comprehensive Cancer Center were identified. Variables from the National Surgical Quality Improvement Program (NSQIP), the tumor registry, and electronic medical records (EMRs) were used to identify frail patients using the revised Risk Analysis Index (RAI-A) score. A score of 38 or higher defined a patient as “frail.” Perioperative outcomes were evaluated using logistic regression and chi-square, and oncologic outcomes were evaluated using Kaplan-Meier analysis.

Results

The study analyzed 411 patients. The mean age at surgery was 75.1 years. The median RAI-A score was 37, and 29.9 % of the patients were frail. The frail patients had significantly higher rates of overall complications (30.1 % vs 14.6 %; p < 0.001). They also had significantly higher rates of postoperative hospitalization longer than 30 days, postoperative delirium, and discharge to rehabilitation. No mortality differences were observed. The 318 patients with colorectal adenocarcinoma undergoing curative-intent resection were evaluated for oncologic outcomes. No differences with frailty in terms of overall survival, disease-specific survival, or progression-free survival were observed except for frail patients with stage 0 or 1 adenocarcinoma, who had worse overall survival than non-frail patients but equivalent other outcomes.

Conclusions

For elderly patients undergoing colorectal surgery, frailty is associated with higher postoperative complications, discharge to rehabitation, and prolonged hospitalization rates. Frailty does not affect long-term oncologic outcomes, so frail elderly patients gain the same oncologic benefit with surgery as non-frail patients.

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Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Eihab Abdelfatah MD, Vicente Ramos-Santillan MD, Leonid Cherkassky MD & Gary Mann MD

  2. Long Island School of Medicine, Division of Surgical Oncology, NYU Langone Health, Mineola, NY, USA

    Eihab Abdelfatah MD

  3. Department of Quality and Patient Safety, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Kristin Cianchetti MS

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  1. Eihab Abdelfatah MD
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Correspondence to Gary Mann MD.

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Abdelfatah, E., Ramos-Santillan, V., Cherkassky, L. et al. High Risk, High Reward: Frailty in Colorectal Cancer Surgery is Associated with Worse Postoperative Outcomes but Equivalent Long-Term Oncologic Outcomes. Ann Surg Oncol 30, 2035–2045 (2023). https://doi.org/10.1245/s10434-022-12970-7

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