Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 893-906
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.893
Impact of frailty on short-term postoperative outcomes in patients undergoing colorectal cancer surgery: A systematic review and meta-analysis
Yao Zhou, Xiao-Lei Zhang, Hong-Xia Ni, Tian-Jing Shao, Ping Wang
Yao Zhou, Hong-Xia Ni, Tian-Jing Shao, Ping Wang, Department of Operating Room, Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong 226361, Jiangsu Province, China
Xiao-Lei Zhang, Department of Gastrointestinal Surgery, The Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, Nantong 226361, Jiangsu Province, China
Co-first authors: Yao Zhou and Xiao-Lei Zhang.
Co-corresponding authors: Tian-Jing Shao and Ping Wang.
Author contributions: Zhou Y and Zhang XL designed the research; Ni HX, and Shao TJ performed the research; Wang P, Zhou Y and Ni HX analysed the data; Shao TJ and Wang P wrote the paper.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tian-Jing Shao, Department of Operating Room, The Affiliated Tumor Hospital of Nantong University & Nantong Tumor Hospital, No. 30 Tongyang Bei Road, Tongzhou District, Nantong 226361, Jiangsu Province, China. 13814708505@163.com
Received: October 18, 2023
Peer-review started: October 18, 2023
First decision: December 12, 2023
Revised: December 28, 2023
Accepted: February 5, 2024
Article in press: February 5, 2024
Published online: March 27, 2024
Abstract
BACKGROUND

Colorectal cancer is a major global health challenge that predominantly affects older people. Surgical management, despite advancements, requires careful consideration of preoperative patient status for optimal outcomes.

AIM

To summarize existing evidence on the association of frailty with short-term postoperative outcomes in patients undergoing colorectal cancer surgery.

METHODS

A literature search was conducted using PubMed, EMBASE and Scopus databases for observational studies in adult patients aged ≥ 18 years undergoing planned or elective colorectal surgery for primary carcinoma and/or secondary metastasis. Only studies that conducted frailty assessment using recognized frailty assessment tools and had a comparator group, comprising nonfrail patients, were included. Pooled effect sizes were reported as weighted mean difference or relative risk (RR) with 95% confidence intervals (CIs).

RESULTS

A total of 24 studies were included. Compared with nonfrail patients, frailty was associated with an increased risk of mortality at 30 d (RR: 1.99, 95%CI: 1.47–2.69), at 90 d (RR: 4.76, 95%CI: 1.56–14.6) and at 1 year (RR: 5.73, 95%CI: 2.74–12.0) of follow up. Frail patients had an increased risk of any complications (RR: 1.81, 95%CI: 1.57–2.10) as well as major complications (Clavien–Dindo classification grade ≥ III) (RR: 2.87, 95%CI: 1.65–4.99) compared with the control group. The risk of reoperation (RR: 1.18, 95%CI: 1.07–1.31), readmission (RR: 1.70, 95%CI: 1.36–2.12), need for blood transfusion (RR: 1.67, 95%CI: 1.52–1.85), wound complications (RR: 1.49, 95%CI: 1.11–1.99), delirium (RR: 4.60, 95%CI: 2.31–9.16), risk of prolonged hospitalization (RR: 2.09, 95%CI: 1.22–3.60) and discharge to a skilled nursing facility or rehabilitation center (RR: 3.19, 95%CI: 2.0–5.08) was all higher in frail patients.

CONCLUSION

Frailty in colorectal cancer surgery patients was associated with more complications, longer hospital stays, higher reoperation risk, and increased mortality. Integrating frailty assessment appears crucial for tailored surgical management.

Keywords: Frailty, Frail adults, Colorectal surgery, Colorectal cancer, Complications, Mortality, Survival, Slinical outcomes, Meta-analysis

Core Tip: This meta-analysis focused on understanding the impact of frailty on short-term outcomes in individuals undergoing colorectal cancer surgery. We analyzed 24 studies involving adult patients aged ≥ 18 years who underwent planned colorectal surgery. Relevant literature search, until August 2023, was conducted using PubMed, EMBASE and Scopus. Observational studies of prospective and retrospective cohort design, as well as case–control studies were included. Pooled findings indicated that frailty was associated with a significant increase in perioperative complications, longer hospital stays, higher risk of reoperation, and increased mortality rate.