Wang Jhih-Sheng, Lai Cheng-Chou, Huang Shu-Huan, Liao Chun-Kai, Hung Yu-Shin, Chou Wen-Chi
Department of Hematology and Oncology, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Risk Manag Healthc Policy. 2025 Aug 25;18:2787-2797. doi: 10.2147/RMHP.S535855. eCollection 2025.
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.
结直肠癌（CRC）对老年人的影响尤为严重，由于与年龄相关的生理脆弱性，给手术治疗带来了巨大挑战。以生理储备减少为特征的衰弱是公认的术后不良结局预测指标。然而，关于术前衰弱对台湾老年CRC患者影响的数据有限。
采用前瞻性收集的2016年至2018年台湾某医疗中心的数据进行回顾性队列研究。对年龄≥65岁接受根治性CRC手术的患者进行包括八个领域的综合老年评估（CGA），以术前评估衰弱情况。患者分为健康（≤1项缺陷）或衰弱（>1项缺陷）。比较两组术后并发症和总生存期（OS）。
179例患者（中位年龄74岁，范围65 - 99岁）中，46.9%被确定为衰弱。营养不良是最常见的缺陷（47%）。衰弱患者重症监护病房入住率（13.1%对3.2%，p = 0.023）、术后主要并发症发生率（50%对26.3%，p = 0.001）显著更高，住院时间更长（中位11天对9天，p = 0.002）。所有三例院内死亡均发生在衰弱患者中。衰弱独立预测较差的OS（调整后风险比1.88，95%置信区间1.02 - 3.73，p = 0.040），并发症风险随衰弱缺陷数量呈剂量依赖性增加。
我们的研究结果显示，术前衰弱在台湾老年结直肠癌患者中普遍存在，且与不良手术和生存结局独立相关。将基于CGA的衰弱评估纳入术前规划可能会加强风险分层，并指导对这一脆弱人群进行个性化的围手术期护理。
