Frailty and surgical outcomes in gastrointestinal cancer: Integration of geriatric assessment and prehabilitation into surgical practice for vulnerable patients.
Kosuke MimaShigeki NakagawaTatsunori MiyataYo-Ichi YamashitaHideo BabaPublished in: Annals of gastroenterological surgery (2022)
As life expectancy increases, the older population continues to grow rapidly, resulting in increased requirement for surgery for older patients with gastrointestinal cancer. Older individuals represent a heterogeneous group in terms of physiological reserves, co-morbidity, cognitive impairment, and disability. Owing to the lack of treatment guidelines for vulnerable patients with gastrointestinal cancer, these patients are more likely to be at risk of undertreatment or overtreatment. Hence, the identification of frail patients with gastrointestinal cancer would improve cancer treatment outcomes. Although there is no standardized geriatric assessment tool, a growing body of research has shown associations of frailty with adverse postoperative outcomes and poor prognosis after resection of gastrointestinal tract and hepatobiliary-pancreatic cancers. Emerging evidence suggests that prehabilitation, which includes exercise and nutritional support, can improve preoperative functional capacity, postoperative recovery, and surgical outcomes, particularly in frail patients with gastrointestinal cancer. We reviewed major geriatric assessment tools for identification of frail patients and summarized clinical studies on frailty and surgical outcomes, as well as prehabilitation or rehabilitation in gastrointestinal tract and hepatobiliary-pancreatic cancers. The integration of preoperative geriatric assessment and prehabilitation of frail patients in clinical practice may improve surgical outcomes. In addition, improving preoperative vulnerability and preventing functional decline after surgery is important in providing favorable long-term survival in patients with gastrointestinal cancer. Further clinical trials are needed to examine the effects of minimally invasive surgery, and chemotherapy in frail patients with gastrointestinal cancer.
Keyphrases
- papillary thyroid
- end stage renal disease
- squamous cell
- community dwelling
- clinical trial
- poor prognosis
- chronic kidney disease
- patients undergoing
- newly diagnosed
- ejection fraction
- prognostic factors
- clinical practice
- physical activity
- peritoneal dialysis
- cognitive impairment
- healthcare
- multiple sclerosis
- childhood cancer
- primary care
- adipose tissue
- young adults
- type diabetes
- lymph node metastasis
- coronary artery disease
- atrial fibrillation
- metabolic syndrome
- randomized controlled trial
- radiation therapy
- middle aged
- squamous cell carcinoma
- climate change
- acute coronary syndrome
- patient reported outcomes
- high intensity
- double blind
- smoking cessation
- bioinformatics analysis
- placebo controlled