Frailty as a predictor of postoperative outcomes in older gastroesophageal cancer patients: a systematic review and meta-analysis

Abstract

Background: Frailty disproportionately impacts older patients with cancer, rendering them at increased risk for poor surgical outcomes. However, the impact of frailty on postoperative outcomes in the population with older gastroesophageal cancer remains unknown. Methods: Systematic review and meta-analysis of studies reporting frailty in older gastroesophageal cancer surgery patients searching Embase, PubMed, Scopus, and Web of Science. The pooled prevalence and odds ratio (OR) with 95% confidence intervals (CI) for mortality and complications estimates were analyzed. The quality of the studies was assessed using the Newcastle–Ottawa Scale (NOS). Data were pooled using random-effects models. Results: A total of 16 studies involving 6143 older patients with gastroesophageal cancer were included. The prevalence of frailty in older gastroesophageal cancer patients was 28% (95% CI = 20–36; p < 0.0001). Frailty was associated with an increased odds ratio for mortality (OR = 2.66; 95% CI = 1.49–4.78; p = 0.0010) and major complication (OR = 2.65; 95% CI = 2.17–3.25; p < 0.0001) compared with non-frail older gastric cancer patients, adjusted for potential confounders. Conclusion: Frailty is frequent in older gastroesophageal cancer patients and may predict adverse outcomes in older gastroesophageal cancer with surgery. The findings underline the significance of frailty evaluation among this population.