European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Impact of frailty on surgical and survival outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
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Bai Zirong, Barker Laura, Koh Cherry, Solomon Michael, Shahab Rihan, Alexander Kate, Karunaratne Sascha, Ansari Nabila, Máximo Pereira Leani Souza, Drummond Lage Ana Paula, Oliveira Leopoldino Amanda Aparecida, Steffens Daniel
Аннотация
BACKGROUND: Frailty is increasingly recognised as a predictor of poor surgical outcomes. However, its impact in determining outcomes following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) remains underreported. Thus, this study aims to determine the association between preoperative frailty and surgical outcomes including survival in patients undergoing CRS + HIPEC.
METHODS: This retrospective cohort study included patients who underwent CRS + HIPEC at the Royal Prince Alfred Hospital between May 2017 and June 2024. Frailty was assessed preoperatively using the Clinical Frailty Scale (CFS), with patients classified as frail (CFS ≥4) or not frail (CFS <4). Other outcomes included surgery duration, intensive care unit (ICU) and hospital stays, postoperative complications, recurrence rates, and survival. Subgroup analyses were performed based on age group (<65 years versus ≥65 years).
RESULTS: Of the 466 patients included, 60 (12.9 %) were classified as frail. Frailty was associated with longer surgery durations (median: 10.0 vs. 9.8 h; p = 0.015), longer ICU stay (median: 5.5 vs. 5.0 days; p = 0.037), hospital stay (median: 21.0 vs. 17.0 days; p < 0.001), and worst survival outcomes (p = 0.002). Age-stratified analysis revealed that frailty was associated with prolonged hospital stay across both subgroups. Among patients aged ≥65 years, frailty was also significantly associated with longer surgery durations (p < 0.001) and length of ICU stay (p = 0.013).
CONCLUSIONS: Preoperative frailty was associated with worse postoperative outcomes in patients undergoing CRS + HIPEC. These findings highlight the importance of routine frailty assessments to guide surgical planning and improve patient care. Future research should explore interventions such as prehabilitation to mitigate the adverse effects of frailty and optimise outcomes in this vulnerable population.
METHODS: This retrospective cohort study included patients who underwent CRS + HIPEC at the Royal Prince Alfred Hospital between May 2017 and June 2024. Frailty was assessed preoperatively using the Clinical Frailty Scale (CFS), with patients classified as frail (CFS ≥4) or not frail (CFS <4). Other outcomes included surgery duration, intensive care unit (ICU) and hospital stays, postoperative complications, recurrence rates, and survival. Subgroup analyses were performed based on age group (<65 years versus ≥65 years).
RESULTS: Of the 466 patients included, 60 (12.9 %) were classified as frail. Frailty was associated with longer surgery durations (median: 10.0 vs. 9.8 h; p = 0.015), longer ICU stay (median: 5.5 vs. 5.0 days; p = 0.037), hospital stay (median: 21.0 vs. 17.0 days; p < 0.001), and worst survival outcomes (p = 0.002). Age-stratified analysis revealed that frailty was associated with prolonged hospital stay across both subgroups. Among patients aged ≥65 years, frailty was also significantly associated with longer surgery durations (p < 0.001) and length of ICU stay (p = 0.013).
CONCLUSIONS: Preoperative frailty was associated with worse postoperative outcomes in patients undergoing CRS + HIPEC. These findings highlight the importance of routine frailty assessments to guide surgical planning and improve patient care. Future research should explore interventions such as prehabilitation to mitigate the adverse effects of frailty and optimise outcomes in this vulnerable population.