Postoperative complications and loss of independence after soft tissue sarcoma surgery in very old patients

The effects of frailty on postoperative complications, functional outcomes, and survival in very old patients undergoing soft tissue sarcoma (STS) surgery remain unclear. Therefore, this study aimed to determine the frequency of postoperative complications and ADL decline, the association of frailty and surgical invasiveness with outcomes, and whether complications or frailty-related factors influence hospital stay length and overall survival.

We retrospectively reviewed 120 patients aged ≥80 years who had undergone resection of localized malignant soft tissue tumors in the limbs or trunk at a single cancer center (2012-2024). Clavien-Dindo classification was used to evaluate their postoperative complications. Primary endpoints were the incidence of complications and the rate of functional decline. Secondary endpoints were length of hospital stay and overall survival. Logistic regression was used to identify factors associated with complications and postoperative care dependency, and the Kaplan-Meier method was used to analyze survival.

Sixty-six patients developed grade ≥ II postoperative complications (both surgery- and nonsurgery-related) with no reported deaths. Multivariate analysis revealed that the Geriatric Nutritional Risk Index risk group and longer operation time were significant factors. Postoperative delirium was the strongest predictor of subsequent functional decline. Patients with complications had a 10.5-day longer hospital stay than those without complications. The 2-year overall survival rate was 74.3%. Postoperative complications did not significantly affect overall survival, whereas frailty was independently associated with poor overall survival.

Malnutrition and cognitive vulnerability were identified as predictors of postoperative complications and loss of independence among very old patients with STS. Incorporating geriatric assessments and prehabilitation strategies may help mitigate these risks and improve outcomes.