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Optimal Assessment of Frailty Predicts Postoperative Complications in Older Patients with Colorectal Cancer Surgery

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Abstract

Objectives

The increasingly elderly worldwide population has affected the incidence of colorectal cancer. Establishment of reliable assessment of frailty and proposals for multi-disciplinary interventions are urgently required in oncology practices. Kihon Checklist (KCL) was published by the Japanese Ministry of Health, Labor and Welfare originally to identify individuals ≥ 65 years old at probable risk for requiring care or social support. We investigate the validity of KCL for frailty assessment to predict postoperative complication in older patients with colorectal cancer.

Methods

Consecutive colorectal cancer patients aged ≥ 65 (n = 500) were prospectively examined between May 2017 and December 2018. Preoperative frailty assessment was conducted by the G8 questionnaire and KCL. The main outcome measures were correlation between frailty, other clinical variables, and postoperative complications within 30 days after elective surgery.

Results

Of the 500 patients, 278 (55.6%) and 164 (32.8%) patients were classified as ‘frail’ by G8 and KCL, respectively. Overall complications counted among 97 patients (19.4%), and they were significantly associated with KCL ≥ 8-frail (46/164, p = 0.001), as opposed to G8 ≤ 14-frail (56/278, p = 0.531). Multivariate analysis showed that KCL ≥ 8 (hazard ratio 1.88, 95% confidence interval 1.16–3.04, p = 0.011) was an independent risk factor for these complications.

Conclusions

KCL assessment can identify frail older patients likely to suffer from postoperative complications after colorectal cancer surgery. Preoperative screening of frailty, particularly by KCL, would help older patients prevent their worse outcomes in colorectal cancer.

Trial registration

UMIN000026689.

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Acknowledgements

All authors appreciate the staff involved with the surgery and treatment. We acknowledge proofreading and editing by Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University.

Funding

The authors declare that they have no sources of funding.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan

    Koichi Tamura, Kenji Matsuda, Hiromitsu Iwamoto, Yuki Mizumoto & Hiroki Yamaue

  2. Department of Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kidohigashimachi, Kawachinagano, Osaka, Japan

    Yoichi Fujita

  3. Department of Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, Japan

    Makoto Iwahashi

  4. Department of Surgery, Naga Municipal Hospital, 1282 Uchida, Kinokawa, Wakayama, Japan

    Kazunari Mori

  5. Department of Surgery, Shingu Municipal Medical Center, 18-7 Hachibuse, Shingu, Wakayama, Japan

    Naohisa Yamade

  6. Department of Surgery, National Hospital Organization Minami Wakayama Medical Center, 27-1 Takinaicho, Tanabe, Wakayama, Japan

    Tsukasa Hotta

  7. Department of Surgery and Endoscopic Surgery, Izumiotsu Municipal Hospital, 16-1 Gejyocyo, Izumiotsu, Osaka, Japan

    Kohei Noguchi

  8. Department of Surgery, Hashimoto Municipal Hospital, 2-8-1 Kominedai, Hashimoto, Wakayama, Japan

    Yoshifumi Sakata

  9. Department of Surgery, Saiseikai Arida Hospital, 52-6, Yuasacho, Arida, Wakayama, Japan

    Katsunari Takifuji

Authors
  1. Koichi Tamura
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  2. Kenji Matsuda
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  3. Yoichi Fujita
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  4. Makoto Iwahashi
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  5. Kazunari Mori
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  6. Naohisa Yamade
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  7. Tsukasa Hotta
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  8. Kohei Noguchi
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  9. Yoshifumi Sakata
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  10. Katsunari Takifuji
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  11. Hiromitsu Iwamoto
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  12. Yuki Mizumoto
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  13. Hiroki Yamaue
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Contributions

KT, KM, and HY contributed to the study conception and design; KT, YF, MI, KM, NY, TH, KN, YS, KT, HI, and YM collected the data; :KM and HY were involved in the analysis and interpretation of data; KT and KM contributed to manuscript writing; HY contributed to the approval of final article.

Corresponding author

Correspondence to Hiroki Yamaue.

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Conflicts of interest

The authors have no conflicts of interest to declare.

Consent to participate

Informed consent was obtained from all individual participants included in this study.

Ethical statement

For this prospective multi-center study, the authors received approval of Wakayama Medical University Ethics Committee following ethical guidelines for medical and health research involving human subjects.

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Tamura, K., Matsuda, K., Fujita, Y. et al. Optimal Assessment of Frailty Predicts Postoperative Complications in Older Patients with Colorectal Cancer Surgery. World J Surg 45, 1202–1209 (2021). https://doi.org/10.1007/s00268-020-05886-4

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  • DOI: https://doi.org/10.1007/s00268-020-05886-4

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