Impact of frailty on 5-year survival in patients older than 70 years undergoing colorectal surgery for cancer

• Published in: World journal of surgical oncology 2021-04, Vol.19 (1), p.106-106, Article 106
• Main Authors: Artiles-Armas, Manuel, Roque-Castellano, Cristina, Fariña-Castro, Roberto, Conde-Martel, Alicia, Acosta-Mérida, María Asunción, Marchena-Gómez, Joaquín
• Format: Article
• Language: English
• Subjects: Activities of daily living; Aged; Aged, 80 and over; Aging; Anastomosis; Canada; Cancer; Care and treatment; Child, Preschool; Cognitive ability; Colorectal cancer; Colorectal carcinoma; Colorectal Surgery; Comorbidity; Complications; Dehiscence; Demographic variables; Development and progression; Digestive System Surgical Procedures; Female; Frail elderly; Frailty; Frailty - epidemiology; Geriatric Assessment; Geriatrics; Humans; Male; Mathematical analysis; Metastases; Mortality; Multivariate analysis; Neoplasms; Patients; Prognosis; Risk analysis; Risk Factors; Surgery; Survival; Tumors
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-021-02221-6

Frailty has been shown to be a good predictor of post-operative complications and death in patients undergoing gastrointestinal surgery. The aim of this study was to analyze the differences between frail and non-frail patients undergoing colorectal cancer surgery, as well as the impact of frailty on long-term survival in these patients. A cohort of 149 patients aged 70 years and older who underwent elective surgery for colorectal cancer was followed-up for at least 5 years. The sample was divided into two groups: frail and non-frail patients. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) was used to detect frailty. The two groups were compared with regard to demographic data, comorbidities, functional and cognitive statuses, surgical risk, surgical variables, tumor extent, and post-operative outcomes, which were mortality at 30 days, 90 days, and 1 year after the procedure. Univariate and multivariate analyses were also performed to determine which of the predictive variables were related to 5-year survival. Out of the 149 patients, 96 (64.4%) were men and 53 (35.6%) were women, with a median age of 75 years (IQR 72-80). According to the CSHA-CFS scale, 59 (39.6%) patients were frail, and 90 (60.4%) patients were not frail. Frail patients were significantly older and had more impaired cognitive status, worse functional status, more comorbidities, more operative mortality, and more serious complications than non-frail patients. Comorbidities, as measured by the Charlson Comorbidity Index (p = 0.001); the Lawton-Brody Index (p = 0.011); failure to perform an anastomosis (p = 0.024); nodal involvement (p = 0.005); distant metastases (p < 0.001); high TNM stage (p = 0.004); and anastomosis dehiscence (p = 0.013) were significant univariate predictors of a poor prognosis on univariate analysis. Multivariate analysis of long-term survival, with adjustment for age, frailty, comorbidities and TNM stage, showed that comorbidities (p = 0.002; HR 1.30; 95% CI 1.10-1.54) and TNM stage (p = 0.014; HR 2.06; 95% CI 1.16-3.67) were the only independent risk factors for survival at 5 years. Frailty is associated with poor short-term post-operative outcomes, but it does not seem to affect long-term survival in older patients with colorectal cancer. Instead, comorbidities and tumor stage are good predictors of long-term survival.