Association of Preoperative Frailty in Older Taiwanese Patients with Colorectal Cancer

Colorectal cancer (CRC) affects older adults disproportionately and presents considerable challenges to surgical management owing to age-related physiological vulnerabilities. Frailty, characterized by a reduced physiological reserve, is a recognized predictor of adverse postoperative outcomes. However, data on the impact of preoperative frailty in Taiwanese older adults with CRC are limited.

A retrospective cohort study was conducted using prospectively collected data from a Taiwanese medical center between 2016 and 2018. A comprehensive geriatric assessment (CGA) encompassing eight domains was performed to preoperatively assess patients aged ≥65 years undergoing curative CRC surgery for frailty. Patients were classified as fit (≤1 deficit) or frail (>1 deficit). Postoperative complications and overall survival (OS) were compared between the groups.

Among 179 patients (median age, 74, range 65‒99), 46.9% were identified as frail. Malnutrition was the most common deficiency (47%). Frail patients had significantly higher rates of intensive care unit admission (13.1% vs 3.2%, p = 0.023), major postoperative complications (50% vs 26.3%, p = 0.001), and longer hospital stay (median 11 vs 9 days, p = 0.002). All three in-hospital deaths occurred in frail patients. Frailty independently predicted worse OS (adjusted hazard ratio 1.88, 95% confidence interval 1.02-3.73, p = 0.040), with a dose-dependent increase in complication risk corresponding to the number of frailty deficits.

Our findings revealed that preoperative frailty is prevalent and independently associated with poor surgical and survival outcomes in older Taiwanese patients with colorectal cancer. Incorporating a CGA-based frailty assessment into preoperative planning may enhance risk stratification and guide tailored perioperative care in this vulnerable population.