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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2016; 8(1): 27-40
Published online Jan 27, 2016. doi: 10.4240/wjgs.v8.i1.27
Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery
Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik
Doris Wagner, Mara McAdams DeMarco, Neda Amini, Stefan Buttner, Dorry Segev, Faiz Gani, Timothy M Pawlik, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States
Mara McAdams DeMarco, Department of Epidemiology, the Johns Hopkins Hospital, Baltimore, MD 21287, United States
Author contributions: Wagner D, DeMarco MM, Amini N and Pawlik TM study concept and design; Wagner D, DeMarco MM, Amini N, Buttner S, Gani F and Pawlik TM acquisited analysis or interpretation of data; all authors contributed to the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Timothy M Pawlik, MD, MPH, PhD, FACS, Professor, Chief, Division of Surgical Oncology, Department of Surgery, the Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, United States. tpawlik1@jhmi.edu
Telephone: +1-410-5022387 Fax: +1-410-5022388
Received: June 24, 2015
Peer-review started: June 24, 2015
First decision: September 17, 2015
Revised: September 19, 2015
Accepted: October 20, 2015
Article in press: October 27, 2015
Published online: January 27, 2016
Abstract

According to the United States census bureau 20% of Americans will be older than 65 years in 2030 and half of them will need an operation - equating to about 36 million older surgical patients. Older adults are prone to complications during gastrointestinal cancer treatment and therefore may need to undergo special pretreatment assessments that incorporate frailty and sarcopenia assessments. A focused, structured literature review on PubMed and Google Scholar was performed to identify primary research articles, review articles, as well as practice guidelines on frailty and sarcopenia among patients undergoing gastrointestinal surgery. The initial search identified 450 articles; after eliminating duplicates, reports that did not include surgical patients, case series, as well as case reports, 42 publications on the impact of frailty and/or sarcopenia on outcome of patients undergoing gastrointestinal surgery were included. Frailty is defined as a clinically recognizable state of increased vulnerability to physiologic stressors resulting from aging. Frailty is associated with a decline in physiologic reserve and function across multiple physiologic systems. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Unlike cachexia, which is typically associated with weight loss due to chemotherapy or a general malignancy-related cachexia syndrome, sarcopenia relates to muscle mass rather than simply weight. As such, while weight reflects nutritional status, sarcopenia - the loss of muscle mass - is a more accurate and quantitative global marker of frailty. While chronologic age is an important element in assessing a patient’s peri-operative risk, physiologic age is a more important determinant of outcomes. Geriatric assessment tools are important components of the pre-operative work-up and can help identify patients who suffer from frailty. Such data are important, as frailty and sarcopenia have repeatedly been demonstrated among the strongest predictors of both short- and long-term outcome following complicated surgical procedures such as esophageal, gastric, colorectal, and hepato-pancreatico-biliary resections.

Keywords: Sarcopenia, Outcomes, Frailty, Morbidity, Mortality

Core tip: It is estimated that by the year 2030, 36 million Americans > 65 years will require surgery. Frailty as defined by a clinically recognizable state of increased vulnerability due to physiologic stressors resulting from aging has been associated with a decreased physiologic reserve and function across multiple physiological systems. Recently, a loss of muscle mass or sarcopenia has been proposed as an accurate and quantitative global marker of frailty. The current review demonstrates that frailty as defined by sarcopenia can be accurately used as a preoperative predictor of poor short- and long-term postoperative outcomes following complex gastrointestinal surgery.