One-Year Changes in Frailty Components After Curative Minimally Invasive Surgery for Colorectal Cancer in Older...

Frailty predicts outcomes after colorectal cancer surgery, but postoperative changes remain unclear. We previously reported improvement in FRAIL Scale-based frail/pre-frail status 1 year after curative minimally invasive surgery (MIS). This study examined the components underlying that improvement using the FRAIL Scale and Kihon Checklist (KCL).

This secondary analysis included patients aged ≥ 70 years who underwent curative MIS for colorectal cancer and had preoperative and 1-year postoperative frailty assessments. Changes in FRAIL Scale and KCL indicators were evaluated using paired analyses.

Among 239 patients assessed preoperatively, 141 were included in the paired analysis. Among FRAIL Scale items, only the weight-loss criterion improved significantly (35.8% to 9.5%, p < 0.001). In the KCL, oral function risk improved, whereas physical function risk tended to worsen; houseboundness, cognitive decline, and depressive mood were unchanged. Patients whose FRAIL Scale weight-loss criterion resolved showed a modest 1.2-kg increase (p = 0.038), whereas mean body weight remained unchanged overall. In sensitivity analyses, the improvement in oral function risk persisted after excluding patients with preoperative bowel obstruction (p = 0.014). After excluding patients receiving oxaliplatin-containing adjuvant chemotherapy, physical function risk still tended to increase, and fear of falling remained significantly increased (p = 0.011).

FRAIL Scale improvement was driven mainly by resolution of the weight-loss criterion, with modest weight gain and no clear overall body-weight recovery. KCL changes varied across domains and items, with improvement in some aspects but persistence or worsening in others, supporting a multidimensional interpretation of postoperative recovery in older patients.