A novel frailty index can predict the short-term outcomes of esophagectomy in older patients with esophageal cancer Journal Article
| Authors: | Boerner, T.; Sewell, M.; Tin, A. L.; Vickers, A. J.; Harrington-Baksh, C.; Bains, M. S.; Bott, M. J.; Park, B. J.; Sihag, S.; Jones, D. R.; Downey, R. J.; Shahrokni, A.; Molena, D. |
| Article Title: | A novel frailty index can predict the short-term outcomes of esophagectomy in older patients with esophageal cancer |
| Abstract: | Background: Frailty, rather than age, is associated with postoperative morbidity and mortality. We sought to determine whether preoperative frailty as defined by a novel scoring system could predict the outcomes among older patients undergoing esophagectomy. Methods: We identified patients 65 years or older who underwent esophagectomy between 2011 and 2021 at our institution. Frailty was assessed using the MSK-FI, which consists of 1 component related to functional status and 10 medical comorbidities. We used a multivariable logistic regression model to test for the associations between frailty and short-term outcomes, with continuous frailty score as the predictor and additionally adjusted for age and Eastern Cooperative Oncology Group performance status. Results: In total, 447 patients were included in the analysis (median age of 71 years [interquartile range, 68–75]). Most of the patients underwent neoadjuvant treatment (81%), an Ivor Lewis esophagectomy (86%), and minimally invasive surgery (55%). A total of 22 patients (4.9%) died within 90 days of surgery, 144 (32%) had a major complication, 81 (19%) were readmitted, and 31 (7.2%) were discharged to a facility. Of the patients who died within 90 days, 19 had a major complication, yielding a failure-to-rescue rate of 13%. The risk of 30-day major complications (OR, 1.24 [95% CI, 1.09–1.41]; p = 0.001), readmissions (OR, 1.31 [95% CI, 1.13–1.52]; p < 0.001), and discharge to a facility (OR, 1.86 [95% CI, 1.49–2.37]; p < 0.001) increased with increasing frailty. Frailty and 90-day mortality were not associated. Conclusions: Frailty assessment during surgery decision-making can identify patients with a high risk of morbidity. © 2024 by the authors. |
| Keywords: | adult; treatment outcome; aged; aged, 80 and over; major clinical study; mortality; neoadjuvant therapy; cancer staging; outcome assessment; prospective study; clinical assessment; morbidity; cohort analysis; postoperative complication; postoperative complications; comorbidity; surgery; gastrectomy; minimally invasive surgery; hospital readmission; epidemiology; esophagus cancer; forced expiratory volume; esophageal adenocarcinoma; decision making; esophagus tumor; esophageal neoplasms; esophagectomy; esophageal squamous cell carcinoma; older patients; complication; ivor lewis esophagectomy; procedures; frailty; very elderly; humans; human; male; female; article; transhiatal esophagectomy; assessment of humans; ecog performance status; american society of anaesthesiologists score; memorial sloan kettering frailty index; novel scoring system; three hole esophagectomy |
| Journal Title: | Current Oncology |
| Volume: | 31 |
| Issue: | 8 |
| ISSN: | 1198-0052 |
| Publisher: | Multimed Inc |
| Date Published: | 2024-08-01 |
| Start Page: | 4685 |
| End Page: | 4694 |
| Language: | English |
| DOI: | 10.3390/curroncol31080349 |
| PUBMED: | 39195332 |
| PROVIDER: | scopus |
| PMCID: | PMC11352928 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Daniela Molena -- Source: Scopus |
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