
==== Front
Ann Surg Oncol
Ann Surg Oncol
Annals of Surgical Oncology
1068-9265
1534-4681
Springer International Publishing Cham

38902416
15662
10.1245/s10434-024-15662-6
ASO Author Reflections
ASO Author Reflections: Impact of Frailty on Liver Surgery
Lunca Sorinel PhD 12
Morarasu Stefan PhD morarasu.stefan@gmail.com

12
1 grid.489076.4 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
2 https://ror.org/03hd30t45 grid.411038.f 0000 0001 0685 1605 Department of Surgery, Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
21 6 2024
21 6 2024
2024
31 10 65786579
4 6 2024
5 6 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
issue-copyright-statement© Society of Surgical Oncology 2024
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pmcPast

The increasing life expectancy around the world exerts pressure on surgical services as more and more elderly patients are recommended major operations when alternative treatments are known to have poor results. In both primary cancer and liver metastasis, surgery is the mainstay of treatment, proven to impact survival rates; however, major liver resection is one of the most complex and high-risk abdominal interventions. For the above reasons, research is needed to better define and stratify frail patients and their outcomes after major liver surgery.1–5

Present

This is the first meta-analysis to compare surgical outcomes between frail and nonfrail patients and underscores the importance of in-depth preoperative evaluation of patients undergoing major liver resections. Frail patients undergoing oncological liver resections have a higher rate of postoperative morbidity, including surgical, medical complications, and postoperative liver failure, with a longer hospital stay and more frequent readmissions. Frail patients have a significantly higher rate of 30-days mortality compared with nonfrail patients. Comparatively, frail patients are older and show a lower preoperative albumin level, suggestive of a poorer nutritional status.

Future

Frailty is defined in many ways by various scores/tools. Before general adoption of frailty in the preoperative evaluation of liver surgery candidates, we must establish an unanimously accepted score for quantifying frailty. This will decrease interstudy heterogeneity, improve extraction of data, multicenter data comparison and, finally, will bring stronger research—a building block for routine implementation of frailty in the preoperative workup.

Funding

No funding or financial assistance was received by the authors.

Disclosure

The authors have no conflict of interest to disclose.

This article refers to: Lunca S, Morarasu S, Rouet K, et al. Frailty increases morbidity and mortality in patients undergoing oncological liver resections: a systematic review and meta-analysis. Ann Surg Oncol. 2024. 10.1245/s10434-024-15571-8.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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