Colorectal
Eihab N. Abdelfatah, MD
Fellow - Complex General Surgical Oncology
Roswell Park Comprehensive Cancer Center
Buffalo, New York, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Frailty is a physiologic state that affects perioperative outcomes. There are a limited number of studies evaluating frailty’s impact on postoperative and long-term oncologic outcomes. We evaluated short term postop and long-term oncologic outcomes in elderly patients undergoing colorectal cancer resection.
Methods:
Patients older than 65 at the time of colorectal resection between July 2011 and September 2020 at Roswell Park Comprehensive Cancer Center were identified. Variables from NSQIP, the tumor registry and the EMR were used to identify frail patients using the revised RAI-A score. Score ≥ 38 was defined as “Frail.” We evaluated perioperative outcomes using logistic regression and chi-square, and long-term oncologic outcomes using Kaplan-Meier analysis.
Results:
411 patients were analyzed. The mean age at surgery was 75.7 years. Median RAI-A score was 37. 29.9% of patients were classified as frail. There were no significant differences between frail and non-frail patients in preop clinical characteristics. Frail patients had significantly higher rates of Clavien-Dindo 2 or higher complications (30.1% vs 14.6%, p < 0.001). Frail patients also had significantly higher rates of postop hospitalization >30 days (p< 0.014) and discharge to rehab (p< 0.014). Stratified by ASA score 3-4, frailty remained a significant factor for these postop outcomes. There was no difference in 30-day mortality between frail and non-frail patients.
The 318 patients with colorectal adenocarcinoma undergoing curative intent resection were evaluated for oncologic outcomes. There was no significant difference between frail and non-frail patients in overall survival, disease specific survival, or progression free survival, even when stratifying by pathologic stage.
Conclusions:
In elderly patients undergoing colorectal surgery, frailty associates with worse postoperative complication, discharge to rehab and prolonged hospitalization rates independent of ASA-graded comorbidity status. However, frailty does not affect long-term oncologic outcomes. Frail elderly patients stand to gain the same therapeutic oncologic benefit as non-frail patients but should undergo preoperative optimization.