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

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A Correction to this article was published on 16 February 2023

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Abstract

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.

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References

  1. Artiles-Armas M, Roque-Castellano C, Fariña-Castro R, Conde-Martel A, Acosta-Mérida MA, Marchena-Gómez J (2021) Impact of frailty on 5-year survival in patients older than 70 years undergoing colorectal surgery for cancer. World J Surg Oncol 19(106). https://doi.org/10.1186/s12957-021-02221-6

  2. González-Senac NM, Mayordomo-Cava J, Macías-Valle A, Aldama-Marín P, González SM, Arnés MLC, Vidán-Astiz MT, Serra-Rexach JA (2021) Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison. Int J Environ Res Public Health 18(11):6072. https://doi.org/10.3390/ijerph18116072

  3. Talarico L, Chen G, Pazdur R (2004) Enrollment of elderly patients in clinical trials for cancer drug registration: A 7-year experience by the US Food and Drug Administration. J Clin Oncol 22(22):4626–4631

    Article  PubMed  Google Scholar 

  4. McMillan. The age old excuse: the under treatment of older cancer patients [Internet]. Vol. 1. 2012 [cited 2021 Dec 8]. Available from: www.macmillan.org.uk/Documents/GetInvolved/Campaigns/AgeOldExcuse/

  5. Aguilar-Frasco JL, Rodríguez-Quintero JH, Moctezuma-Velázquez P, Morales-Maza J, Moctezuma-Velázquez C, Pastor-Sifuentes F et al (2021) Frailty index as a predictive preoperative tool in the elder population undergoing major abdominal surgery: a prospective analysis of clinical utility. Langenbeck’s Arch Surg 406(4):1189–1198

    Article  Google Scholar 

  6. Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ et al (2015) The prevalence and outcomes of frailty in older cancer patients: A systematic review. Ann Oncol 26(6):1091–101. https://doi.org/10.1093/annonc/mdu540

    Article  CAS  PubMed  Google Scholar 

  7. Desserud KF, Veen T, Søreide K (2016) Emergency general surgery in the geriatric patient. Br J Surg 103(2):e52–61. Available from: https://pubmed.ncbi.nlm.nih.gov/26620724/

  8. Kim SW, Han HS, Jung HW, Kim K Il, Hwang DW, Kang SB et al (2014) Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg 149(7):633–40. Available from: https://pubmed.ncbi.nlm.nih.gov/24804971/

  9. Fagard K, Leonard S, Deschodt M, Devriendt E, Wolthuis A, Prenen H et al (2016) The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: A systematic review. J Geriatr Oncol 7(6):479–91. https://doi.org/10.1016/j.jgo.2016.06.001

    Article  PubMed  Google Scholar 

  10. Balducci L, Colloca G, Cesari M, Gambassi G (2010) Assessment and treatment of elderly patients with cancer. Surg Oncol 19(3):117–123

    Article  PubMed  Google Scholar 

  11. Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D et al (2015) Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 26(3):463–476

    Article  CAS  PubMed  Google Scholar 

  12. Clegg A, Rogers L, Young J (2015) Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing 44(1):148–52. Available from: https://academic.oup.com/ageing/article/44/1/148/2812365

  13. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381(9868):752–762

    Article  PubMed  Google Scholar 

  14. Ghignone F, Van Leeuwen BL, Montroni I, Huisman MG, Somasundar P, Cheung KL et al (2016) The assessment and management of older cancer patients: A SIOG surgical task force survey on surgeons’ attitudes. Eur J Surg Oncol 42(2):297–302. Available from: https://pubmed.ncbi.nlm.nih.gov/26718329/

  15. Shahrokni A, Tin A, Alexander K, Sarraf S, Afonso A, Filippova O et al (2019) Development and Evaluation of a New Frailty Index for Older Surgical Patients With Cancer. JAMA Netw open 2(5). Available from: https://pubmed.ncbi.nlm.nih.gov/31074814/

  16. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al (2010) Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 39(4):412–23. Available from: https://pubmed.ncbi.nlm.nih.gov/20392703/

  17. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107(6):931–6. Available from: https://pubmed.ncbi.nlm.nih.gov/22871883/

  18. Martin L, Birdsell L, MacDonald N, Reiman T, Clandinin MT, McCargar LJ et al (2013) Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol 31(12):1539–47. Available from: https://pubmed.ncbi.nlm.nih.gov/23530101/

  19. Moctezuma-Velázquez P, Vergara-Fernández O, Salgado-Nesme N, Aguilar-Frasco JL, Sainz-Hernández JC, Moctezuma-Velázquez C (2021) Influence of Muscle Mass Area and Visceral Obesity on 30-day Mortality After Colorectal Surgery with Primary Anastomosis. Rev Invest Clin 73(6). Available from: https://pubmed.ncbi.nlm.nih.gov/34128945/

  20. Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF (2012) Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 215(4):453–66. Available from: https://pubmed.ncbi.nlm.nih.gov/22917646/

  21. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S et al (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol 55(3):241–52. Available from: https://pubmed.ncbi.nlm.nih.gov/16084735/

  22. ACS National Surgical Quality Improvement Program. Available from: https://www.facs.org/quality-programs/acs-nsqip

  23. Schneider CA, Rasband WS, Eliceiri KW (2012) NIH Image to ImageJ: 25 years of image analysis. Nat Methods 9(7):671–5. Available from: https://pubmed.ncbi.nlm.nih.gov/22930834/

  24. Prado CM, Lieffers JR, McCargar LJ, Reiman T, Sawyer MB, Martin L et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9(7):629–35. Available from: https://pubmed.ncbi.nlm.nih.gov/18539529/

  25. Bentov I, Kaplan SJ, Pham TN, Reed MJ (2019) Frailty assessment: from clinical to radiological tools. Br J Anaesth 123(1):37–50. Available from: https://pubmed.ncbi.nlm.nih.gov/31056240/

  26. Shaw JF, Mulpuru S, Kendzerska T et al (2022) Association between frailty and patient outcomes after cancer surgery: a population- based cohort study. Br J Anaesth 128(3):457–464

    Article  PubMed  Google Scholar 

  27. Dolan DR, Knight KA, Maguire S, Moug SJ (2019) The relationship between sarcopenia and survival at 1 year in patients having elective colorectal cancer surgery. Tech Coloproctol 23(9):877–85. Available from: https://pubmed.ncbi.nlm.nih.gov/31486988/

  28. Reisinger KW, Van Vugt JLA, Tegels JJW, Snijders C, Hulsewé KWE, Hoofwijk AGM et al (2015) Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg 261(2):345–52. Available from: https://pubmed.ncbi.nlm.nih.gov/24651133/

  29. Sun G, Li Y, Peng Y, Lu D, Zhang F, Cui X et al (2018) Can sarcopenia be a predictor of prognosis for patients with non-metastatic colorectal cancer? A systematic review and meta-analysis. Int J Colorectal Dis 33(10):1419–27. Available from: https://pubmed.ncbi.nlm.nih.gov/29987364/

  30. Milder DA, Pillinger NL, Kam PCA (2018) The role of prehabilitation in frail surgical patients: a systematic review. Acta Anaesthesiol Scand 62:1356–1366

    Article  PubMed  Google Scholar 

  31. Baimas-George M, Watson M, Elhage S, Parala-Metz A, Vrochides D, Davis BR (2020) Prehabilitation in frail surgical patients: a systematic review. World JSurg 44:3668–3678

    Article  Google Scholar 

  32. Kelly CM, Shahrokni A (2016) Moving beyond Karnofsky and ECOG Performance Status Assessments with New Technologies. J Oncol Available from: /pmc/articles/PMC4811104/

  33. Denholm Mary, Corrie Pippa, Qian Wendi HJ (2017) The Rockwood Geriatric Clinical Frailty Scale is a more discriminatory tool for assessing older cancer patients compared with standard oncology performance status scales. - NCRI Cancer Conference abstracts Abstract. Available from: https://abstracts.ncri.org.uk/abstract/the-rockwood-geriatric-clinical-frailty-scale-is-a-more-discriminatory-tool-for-assessing-older-cancer-patients-compared-with-standard-oncology-performance-status-scales/

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Acknowledgements

We appreciate the support from the Department of Colorectal Surgery at Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” for facilitating data acquisition for this study.

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Authors and Affiliations

  1. Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición “Salvador Zubirán, ” Vasco de Quiroga 15, Mexico City, México

    Paulina Moctezuma-Velázquez, Emma Castro, Francisco Armillas-Canseco, Cristian Axel Hernández-Gaytán & Carlos Moctezuma-Velázquez

  2. Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA

    Jorge Humberto Rodríguez-Quintero

  3. Department of Surgical Oncology, Instituto Nacional de Cancerología. Av, San Fernando 22 Belisario Domínguez Secc. 16, Tlalpan, 14080, Mexico City, México

    Jorge Luis Aguilar-Frasco & Francisco U. Pastor-Sifuentes

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  1. Jorge Luis Aguilar-Frasco
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Contributions

Study conception and design was made by JLAF and CMV. Acquisition of data was made by JLAF, EC, FAC, CAHG, and FUPS. Analysis and interpretation of data were made by JLAF, CMV, and PMV. Drafting of the manuscript was made by JLAF, JHRQ, PMV, and CMV. Critical revision and approval of the manuscript was made by JLAF, JHRQ, PMV, and CMV.

Corresponding author

Correspondence to Jorge Luis Aguilar-Frasco.

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Ethics approval

This research was performed in accordance with the 1964 Helsinki declaration and its later amendments and was approved by our institutional ethics committee.

Informed consent

Informed consent was obtained to analyze the data of all study participants.

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The authors declare no competing interests.

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Appendix 1

Appendix 1

Table 5

Table 5 Surgical procedures and complications
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Aguilar-Frasco, J.L., Moctezuma-Velázquez, P., Rodríguez-Quintero, J.H. et al. Preoperative frailty assessment in older patients with colorectal cancer: use of clinical and radiological tool. Langenbecks Arch Surg 408, 19 (2023). https://doi.org/10.1007/s00423-023-02754-2

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