Impact of Frailty Upon Surgical Decision-Making for Left-Sided Colon Cancer

Area of Science:

• Colorectal Surgery
• Geriatric Surgery
• Surgical Oncology

Background:

• Frailty, characterized by reduced physiological reserve, increases morbidity in colon cancer patients post-resection.
• A common surgical belief is that frail patients cannot tolerate anastomotic leak complications, favoring end colostomy over primary anastomosis for left-sided colon cancer.

Purpose of the Study:

• To investigate the impact of patient frailty on surgical approach and outcomes in left-sided colon cancer.

Main Methods:

• Utilized the American College of Surgeons National Surgical Quality Improvement Program database (2016-2018).
• Analyzed data from 17,461 patients undergoing left-sided colectomy, categorized by the modified 5-item frailty index.
• Employed multivariate regression to identify predictors of complications and operative type.

Main Results:

• 20.7% of patients were identified as frail.
• Frail patients had a higher incidence of end colostomy compared to non-frail patients (11.3% vs 9.6%, P=0.01).
• Frailty predicted increased total medical complications (OR 1.45) and readmission (OR 1.53), but not organ space surgical site infections or reoperation. An end colostomy did not reduce reoperation or organ space infection risk.

Conclusions:

• Frail patients with left-sided colon cancer are more likely to undergo end colostomy, yet this approach does not mitigate risks of reoperation or organ space surgical site infections.
• Frailty status alone should not be the sole determinant for performing an end colostomy in this patient group.
• Further research is essential to refine surgical decision-making for frail individuals with left-sided colon cancer.