Frailty Recovery Following Minimally Invasive Surgery: An Emerging Perspective on Surgical Benefits in Elderly Colorectal Cancer Patients

Sep 28, 2026

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Frailty is common among elderly colorectal cancer (CRC) patients and influences perioperative and long-term outcomes, yet how minimally invasive surgery (MIS) affects frailty remains insufficiently defined. In a prospective observational study of 239 CRC patients aged 70+ undergoing MIS with R0 resection, frailty was assessed preoperatively and 1 year postoperatively using the FRAIL Scale and Kihon Checklist. Results showed comparable short-term outcomes, but worse overall survival in frail patients; among recurrence-free patients, frailty improved and hemoglobin, nutritional index, and psoas muscle index increased.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Frailty in elderly colorectal cancer

Role and limitations of minimally invasive surgery

Frailty assessment tools

Materials and Methods

Study design

Frailty evaluation timeline

Annals of Gastroenterological Surgery ORIGINAL ARTICLE OPEN ACCESS Frailty Recovery Following Minimally Invasive Surgery: An Emerging Perspective on Surgical Benefits in Elderly Colorectal Cancer Patients Hajime Ushigome | Yushi Yamakawa | Shunsuke Hayakawa | Akira Kato | Takuya Suzuki | Takafumi Sato | Hiroyuki Sagawa | Ryo Ogawa | Hiroki Takahashi | Shuji Takiguchi Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan Correspondence: Hajime Ushigome ([hajime.since1980@gmail.com](hajime.since1980@gmail.com)) Received: 5 June 2025 | Revised: 12 July 2025 | Accepted: 21 July 2025 Funding: The authors received no specific funding for this work. Keywords: colorectal cancer | frailty | frailty recovery | minimally invasive surgery | robot-assisted surgery ABSTRACT Background: Frailty is common among elderly colorectal cancer (CRC) patients and affects both perioperative and long-term outcomes. However, many aspects of how minimally invasive surgery (MIS) influences frailty remain unclear. Moreover, very few reports have specifically evaluated postoperative changes in frailty status. Methods: In this prospective observational study, 239 CRC patients aged ≥70years undergoing MIS with R0 resection were assessed for frailty using the FRAIL Scale and Kihon Checklist preoperatively and 1 year postoperatively. Short-and long-term oncological outcomes and frailty status changes were analyzed. Results: A total of 88 patients (37%) were diagnosed as frail on the basis of either of the frailty assessment tools, and MIS was performed in all cases. Short-term outcomes were comparable between frail and non-frail patients; however, overall survival (OS) was significantly worse in frail patients (log-rank, p = 0.01). Among the 141 patients who remained recurrence-free for 1year and completed the second questionnaire, frailty status significantly improved according to the FRAIL Scale (p = 0.001) . In patients whose frailty status improved, significant improvements in hemoglobin levels, the prognostic nutritional index, and psoas muscle index were observed compared with their preoperative values. Conclusions: Curative MIS was safely performed in elderly frail colorectal cancer patients without increasing perioperative complications; however, their long-term outcomes remained poor. Nevertheless, in patients who remained recurrence-free, frailty status significantly improved 1 year after surgery, suggesting an emerging potential benefit of surgical resection in the elderly population. 1 | Introduction Colorectal cancer (CRC) is one of the most common gastrointestinal malignancies in both Asia and Western countries. In recent years, the aging of the global population has led to a steady increase in elderly patients with CRC, with approximately 50% of patients aged 70 years or older and more than 40% aged 75 years or older [1] . Surgical resection remains the cornerstone of treatment for CRC in elderly patients; however, age-related vulnerabilities—physical, psychological, and social, collectively referred to as frailty—are frequently observed in this population. Frailty has been identified not only as a risk factor for poor short-term outcomes but also as a predictor of long-term prognosis, functional recovery, and quality of life [2–6]. Therefore, frailty assessment, which evaluates the overall vulnerability of elderly patients This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery. Annals of Gastroenterological Surgery, 2026; 10:137–144 137 [https://doi.org/10.1002/ags3.70070](https://doi.org/10.1002/ags3.70070) beyond conventiona

FAQs

How was frailty assessed before and after surgery?

Frailty was evaluated using the FRAIL Scale and the Kihon Checklist preoperatively and again 1 year after minimally invasive surgery.

Did minimally invasive surgery change short-term outcomes in frail patients?

Short-term outcomes were comparable between frail and non-frail patients, indicating no increase in perioperative complications in frail patients.

What happened to frailty status one year after surgery in recurrence-free patients?

Among patients who remained recurrence-free and completed the second questionnaire, frailty status significantly improved on the FRAIL Scale, alongside improvements in hemoglobin, the prognostic nutritional index, and psoas muscle index.

Sep 28, 2026

Uploaded by acoobca