The impact of frailty on clinical outcomes in colorectal cancer surgery : a systematic literature review
© 2021 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons..
BACKGROUND: The majority of colorectal cancer is diagnosed in people aged >65 years, yet the elderly are less likely to undergo curative surgery. Chronological age is poorly correlated with post-operative outcomes and is not an acceptable measure of risk. Conversely, frailty is a strong predictor of poor post-operative outcomes and presents an opportunity for optimisation. This systematic review aims to assess the evidence between frailty and outcomes in patients of all ages undergoing colorectal cancer resections and to compare the predictive value of frailty status to that of age alone.
METHODS: The review was registered on Prospero, CRD42019150542. PubMed was searched for articles reporting outcomes for frail patients undergoing elective or emergency colorectal cancer resection up until August 2019. All studies reporting outcomes in frail patients were deemed eligible for inclusion and assessed according to the PRISMA guidelines.
RESULTS: Of the 143 identified studies, 17 were eligible for inclusion. Study type, frailty assessments and outcomes measured were highly variable. 'Frailty' was associated with significantly higher rates of post-operative complications (7/7 studies), post-operative mortality (5/7 studies), readmission (3/4 studies) and length of stay (3/3 studies). Seven of 11 studies reported no association between age and adverse outcomes.
CONCLUSION: Frailty is a predictor of poor clinical outcomes in patients undergoing surgery for colorectal cancer. Standardisation of frailty assessment and outcome measure is needed. Accurate risk stratification of patients will allow us to make informed treatment decisions, identify patients who may benefit from preoperative intervention and tailor post-operative care.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:91 |
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| Enthalten in: |
ANZ journal of surgery - 91(2021), 11 vom: 01. Nov., Seite 2322-2329 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Michaud Maturana, Mailis [VerfasserIn] |
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| Links: |
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| Themen: |
Colorectal cancer |
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| Anmerkungen: |
Date Completed 15.11.2021 Date Revised 15.11.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/ans.16941 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM32563100X |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons. | ||
| 520 | |a BACKGROUND: The majority of colorectal cancer is diagnosed in people aged >65 years, yet the elderly are less likely to undergo curative surgery. Chronological age is poorly correlated with post-operative outcomes and is not an acceptable measure of risk. Conversely, frailty is a strong predictor of poor post-operative outcomes and presents an opportunity for optimisation. This systematic review aims to assess the evidence between frailty and outcomes in patients of all ages undergoing colorectal cancer resections and to compare the predictive value of frailty status to that of age alone | ||
| 520 | |a METHODS: The review was registered on Prospero, CRD42019150542. PubMed was searched for articles reporting outcomes for frail patients undergoing elective or emergency colorectal cancer resection up until August 2019. All studies reporting outcomes in frail patients were deemed eligible for inclusion and assessed according to the PRISMA guidelines | ||
| 520 | |a RESULTS: Of the 143 identified studies, 17 were eligible for inclusion. Study type, frailty assessments and outcomes measured were highly variable. 'Frailty' was associated with significantly higher rates of post-operative complications (7/7 studies), post-operative mortality (5/7 studies), readmission (3/4 studies) and length of stay (3/3 studies). Seven of 11 studies reported no association between age and adverse outcomes | ||
| 520 | |a CONCLUSION: Frailty is a predictor of poor clinical outcomes in patients undergoing surgery for colorectal cancer. Standardisation of frailty assessment and outcome measure is needed. Accurate risk stratification of patients will allow us to make informed treatment decisions, identify patients who may benefit from preoperative intervention and tailor post-operative care | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Systematic Review | |
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| 650 | 4 | |a frailty | |
| 650 | 4 | |a prehabilitation | |
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| 700 | 1 | |a Nandakumar, Madura |e verfasserin |4 aut | |
| 700 | 1 | |a Li Chen, John |e verfasserin |4 aut | |
| 700 | 1 | |a Dvorkin, Lee |e verfasserin |4 aut | |
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