Frailty Predicts Severe Postoperative Complications After Elective Minimally Invasive Surgery in Patients with Colorectal Cancer

Abstract

To examine whether frailty is associated with postoperative complications in patients undergoing laparoscopic colorectal surgery. Patients over 65 years of age undergoing laparoscopic colorectal surgery from 2011 to 2016 at Saiseikai Kumamoto Hospital were enrolled. Frailty was defined by the Clinical Frailty Scale (CFS). Sarcopenia was defined as the total muscle area at the level of the third lumbar vertebra (L3) measured on computed tomography (CT). Relevance of the CFS score and sarcopenia to severe postoperative complications was assessed. Among 193 patients analyzed, 45 (23%) were frail and 122 (63%) had sarcopenia. Frailty was associated with older age (P < 0.0001), surgical site infection (P = 0.011), anastomotic leakage (P = 0.033), severe postoperative complications (Clavien–Dindo ≥ 3) (P = 0.0009), and postoperative in-hospital stay (P < 0.0001). In contrast, sarcopenia was not associated with postoperative outcomes. Low anterior resection and frailty were independent predictors of severe postoperative complications (risk ratios of 4.1 [P = 0.016 ] and 5.9 [P = 0.0005], respectively). With regard to severe postoperative complications, the occurrence of superficial surgical site infection and anastomotic leakage was significantly higher in the frailty group than that in the non-frailty group (P = 0.043 and 0.035, respectively). Frailty, but not sarcopenia, is a robust predictor of severe postoperative complications in patients undergoing endoscopic colorectal surgery.