A Systematic Review of the Utility of Frailty and Sarcopenia Measures in Patients undergoing Surgery for Gastrointestinal Cancer

Background: Identifying patient factors that impact the risks associated with and outcomes following resectional gastrointestinal (GI) cancer surgery is a potentially important strategy in achieving improved cancer survival. Methods: A search of Medline, BNI, Cochrane, Embase and CINAHL databases was performed, and English language publications of the period 1990–2016 reporting on the outcome of survival following gastrointestinal cancer surgery in patients that underwent an assessment of either frailty or sarcopenia preoperatively were included. Results: 26 articles were included. Two studies compared methods of frailty assessment, ten studies assessed either frailty or aspects of a comprehensive geriatric assessment (CGA) as a predictor of outcome, and fourteen studies assessed sarcopenia as a predictor of outcome. 2 studies found that CGA assessment was an accurate method of assessment, with the abbreviated CGA having an accuracy rate of 83% against a reference standard of a geriatric assessment, and another study found identification of significantly more patients as frail compared to a physical phenotype alone (43% vs 13% in physical phenotype of frailty, respectively). A significant difference in 90-day, 1 year and 5-year survival was seen between frail and nonfrail patients (90-day survival: OR 10.4, 95% CI 7.6-14.2, p<0.001; 1- year survival: OR 8.4, 95% CI 6.4- 11.1, p<0.001; 5- year survival 66% vs 24% frail vs non-frail, respectively). Conclusion: There is clear evidence that increased frailty and sarcopenia leads to a reduction in short- and long-term survival. Patients should undergo frailty or sarcopenia assessment, but the best means of assessment remains unclear.