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
Processing time: 155 Days and 15.6 Hours
ARTICLE HIGHLIGHTS
Research background

Colorectal cancer presents a significant healthcare challenge. The management is centered on surgical procedures, with or without neoadjuvant therapy. While advancements in surgical techniques have improved outcomes, recent evidence highlights the critical role of preoperative frailty in influencing postoperative results. Our review aimed to update existing evidence on the impact of preoperative frailty on survival and other key clinical outcomes in subjects with colorectal cancer undergoing elective surgery.

Research motivation

To update existing evidence, through inclusion of contemporary studies, in order to guide clinical practice.

Research objectives

To identify and include all relevant studies to analyze and document the association of frailty with short-term postoperative outcomes in patients undergoing colorectal cancer surgery.

Research methods

A comprehensive literature search was conducted using PubMed, EMBASE and Scopus to identify observational studies involving adults (age ≥ 18 years) undergoing planned colorectal surgery for primary carcinoma and/or secondary metastasis. Included studies utilized recognized frailty assessment tools and featured a comparator group of nonfrail patients. Pooled effect sizes, along with 95% confidence intervals, were reported.

Research results

A total of 24 studies were included. Frailty was found to be associated with increased risk of mortality at 30 d, 90 d and 1 year of follow-up. Frail patients had increased risk of overall complications as well as major complications, compared with the nonfrail patients. The risk of need for reoperation, readmission, need for blood transfusion, wound complications, delirium, risk of prolonged hospitalization and discharge to skilled nursing facility or rehabilitation center was higher in frail patients.

Research conclusions

In patients undergoing colorectal cancer surgery, frailty was associated with a significant increase in perioperative complications, longer hospital stay, higher risk of reoperation and increased mortality rate.

Research perspectives

This finding of this meta-analysis emphasizes the crucial role of frailty as a predictive factor for adverse postoperative outcomes in colorectal cancer surgery. They further call for integration of frailty assessment into routine clinical practice to enhance patient care and guide treatment decisions.