Preoperative frailty assessment in older patients with colorectal cancer: use of clinical and radiological tool.

Autor: Aguilar-Frasco JL; Department of Surgical Oncology, Instituto Nacional de Cancerología. Av, San Fernando 22 Belisario Domínguez Secc. 16, Tlalpan, 14080, Mexico City, México. afrascoo@gmail.com., Moctezuma-Velázquez P; Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición 'Salvador Zubirán, ' Vasco de Quiroga 15, Mexico City, México., Rodríguez-Quintero JH; Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA., Castro E; Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición 'Salvador Zubirán, ' Vasco de Quiroga 15, Mexico City, México., Armillas-Canseco F; Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición 'Salvador Zubirán, ' Vasco de Quiroga 15, Mexico City, México., Hernández-Gaytán CA; Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición 'Salvador Zubirán, ' Vasco de Quiroga 15, Mexico City, México., Pastor-Sifuentes FU; Department of Surgical Oncology, Instituto Nacional de Cancerología. Av, San Fernando 22 Belisario Domínguez Secc. 16, Tlalpan, 14080, Mexico City, México., Moctezuma-Velázquez C; Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición 'Salvador Zubirán, ' Vasco de Quiroga 15, Mexico City, México.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2023 Jan 11; Vol. 408 (1), pp. 19. Date of Electronic Publication: 2023 Jan 11.
DOI: 10.1007/s00423-023-02754-2
Abstrakt: Purpose: The Memorial Sloan Kattering Frailty Index (MSK-FI) and the Skeletal Muscle Index (SMI) have recently gained attention as markers of frailty and decreased physiologic reserve, and are promising as predictors of adverse postoperative outcomes in patients undergoing oncologic surgery. The objective of this study was to establish the prognostic accuracy of these indexes in a cohort of patients with colorectal cancer subjected to surgical intervention.
Methods: We performed an observational study including all patients older than 60 years, subjected to colorectal cancer surgery between January 2010 and May 2020, and stratified our cohort based on the presence of frailty, as defined by MSK-FI ≥ 3. Computed tomography was used to calculate SMI, using a standardized institutional protocol. A multivariable analysis was used to study the association between these novel indexes with adverse postoperative outcomes in our cohort.
Results: A total of 216 patients were included. Among these, 56 (26%) qualified as frail and 132 (62%) had a low SMI. On multivariable analysis (adjusted by patient and intraoperative characteristics), frailty was associated with increased risk of having a major postoperative complication (OR 29.78, 95%CI 10.36-85.71) and increased admission to the intensive care unit (OR 4.99, 95%CI 1.55-16.06), while both frailty and low SMI were associated with prolonged length of stay (OR 11.22, 95%CI 8.91-13.53 and OR 0.14, 95% CI 0.06-0.20, respectively).
Conclusion: MSK-FI ≥ 3 and low SMI are associated with adverse postoperative outcomes in elderly patients undergoing colorectal cancer surgery. Implementing this practical tool in routine clinical practice, may help identify patients that would benefit from surgical prehabilitation and preoperative optimization to improve outcomes.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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