Frailty Linked To Adverse Perioperative Outcomes In Older Patients With Oesophageal Cancer

Author: By Shreeya Nanda, Senior medwireNews Reporter

medwireNews: A US single-institution study has demonstrated an association between frailty as evaluated by a novel index and poor short-term outcomes following oesophagectomy in older people with oesophageal cancer.

“Incorporating frailty assessment in surgery decision-making might help identify a subgroup of patients at major risk for morbidity for which specific interventions can be tailored to improve outcomes”, said presenter Daniela Molena, from Memorial Sloan Kettering Cancer Center (MSKCC) in New York, USA, at the ESMO World Congress on Gastrointestinal Cancer 2022 in Barcelona, Spain.

She outlined several possible interventions that could come into play, such as preoperative optimisation, appropriate referral to tertiary centres, and careful monitoring and prompt treatment of complications.

The chart review included data on 447 patients aged at least 65 years who underwent oesophagectomy at MSKCC between January 2011 and March 2021. Patients were aged a median of 71 years, and the majority were men (81%), of White ethnicity (88%) and had received neoadjuvant therapy (81%).

A total of 86.0% of patients underwent Ivor Lewis oesophagectomy and 55.0% had minimally invasive surgery, with a median hospital stay of 10 days. Twenty-eight percent experienced a serious complication, defined as an event of grade 3 or worse, and 3.2% died in hospital.

Daniela Molena reported that they applied the MSK frailty index – which is based on functional status and 10 comorbidities – to the study population, and found that 16.0% had a score of 0 points, while 28.0%, 26.0%, 13.0%, 8.5%, 4.3% and 3.8% had scores of 1, 2, 3, 4, 5 and 6–11 points, respectively.

After multivariable adjustment, the MSK frailty index as a continuous variable was significantly associated with an increased risk for having a major complication within 30 days of surgery, readmission within 30 days of discharge and discharge to a facility, with respective odds ratios (ORs) of 1.23, 1.32 and 1.86.

By contrast, there was no significant association between the MSK frailty index and death within 90 days of surgery, which Daniela Molena told medwireNews “is probably due to our ability to rescue patients from even serious complication.”

She also highlighted that the associations between frailty and major complications as well as readmission rates were “nearly linear”, while “for discharge to a facility, there seems to be a step increase for patients with a score of 3 points or more.”

With regard to the next steps, Daniela Molena said that “[t]he question is whether very frail patients would benefit from a preoperative intervention to improve the individual functional status or if a less-invasive therapy may be a better first-line treatment approach.”

And she concluded: “We hope this evaluation in older individuals will help patients and physician[s] make a better therapeutic decision tailored to their specific needs and goals of care.”

Reference

• Boerner T, Tin A, Vickers A, et al. Novel frailty index predicts short-term outcomes after esophagectomy in elderly patients with esophageal cancer. Ann Oncol 2022; 33 (suppl 4): S358. doi: 10.1016/j.annonc.2022.04.405