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Past
The increasing life expectancy around the world exerts pressure on surgical services as more and more elderly patients are recommended major operations when alternative treatments are known to have poor results. In both primary cancer and liver metastasis, surgery is the mainstay of treatment, proven to impact survival rates; however, major liver resection is one of the most complex and high-risk abdominal interventions. For the above reasons, research is needed to better define and stratify frail patients and their outcomes after major liver surgery.1,2,3,4,5
Present
This is the first meta-analysis to compare surgical outcomes between frail and nonfrail patients and underscores the importance of in-depth preoperative evaluation of patients undergoing major liver resections. Frail patients undergoing oncological liver resections have a higher rate of postoperative morbidity, including surgical, medical complications, and postoperative liver failure, with a longer hospital stay and more frequent readmissions. Frail patients have a significantly higher rate of 30-days mortality compared with nonfrail patients. Comparatively, frail patients are older and show a lower preoperative albumin level, suggestive of a poorer nutritional status.
Future
Frailty is defined in many ways by various scores/tools. Before general adoption of frailty in the preoperative evaluation of liver surgery candidates, we must establish an unanimously accepted score for quantifying frailty. This will decrease interstudy heterogeneity, improve extraction of data, multicenter data comparison and, finally, will bring stronger research—a building block for routine implementation of frailty in the preoperative workup.
References
Lunca S, Morarasu S, Rouet K, et al. Frailty increases morbidity and mortality in patients undergoing oncological liver resections: a systematic review and meta-analysis. Ann Surg Oncol. 2024. https://doi.org/10.1245/s10434-024-15571-8.
Audisio RA, van Leeuwen BL. Beyond “age”: frailty assessment strategies improve care of older patients with cancer. Ann Surg Oncol. 2015;22(12):3774–5. https://doi.org/10.1245/s10434-015-4772-0.
Shinall MC Jr, Arya S, Youk A, et al. Association of preoperative patient frailty and operative stress with postoperative mortality. JAMA Surg. 2020;155(1):e194620. https://doi.org/10.1001/jamasurg.2019.4620.
Aloia TA, Fahy BN, Fischer CP, et al. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford). 2009;11(6):510–5. https://doi.org/10.1111/j.1477-2574.2009.00095.x.
Yamada S, Shimada M, Morine Y, et al. Significance of frailty in prognosis after hepatectomy for elderly patients with hepatocellular carcinoma. Ann Surg Oncol. 2021;28(1):439–46. https://doi.org/10.1245/s10434-020-08742-w.
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This article refers to: Lunca S, Morarasu S, Rouet K, et al. Frailty increases morbidity and mortality in patients undergoing oncological liver resections: a systematic review and meta-analysis. Ann Surg Oncol. 2024. https://doi.org/10.1245/s10434-024-15571-8.
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Lunca, S., Morarasu, S. ASO Author Reflections: Impact of Frailty on Liver Surgery. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15662-6
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DOI: https://doi.org/10.1245/s10434-024-15662-6