http://orcid.org/0000-0001-9073-2667
Along with population aging, frailty is an emerging problem in developed countries [Citation1]. Issues associated with advanced age affect a broad spectrum of items including treatment of colorectal cancer, which is currently the most common gastrointestinal malignancy worldwide. It has been proven that frailty is associated with higher mortality and higher complication rates, whereas age itself is not [Citation2]. Moreover, recent changes in perioperative care and the successful introduction of enhanced recovery after surgery (ERAS) protocols improve short- and long-term outcomes [Citation3]. According to the contemporary understanding of recovery, tolerance of food without nausea and regained mobility are the most important targets [Citation4]. This is in line with the principles of ERAS protocols which have been successfully implemented, showing indisputable benefits also among the elderly [Citation5].
In the study entitled “Association of Frailty with Delayed Recovery of Gastrointestinal Function after Elective Colorectal Cancer Resections” the link between frailty and delayed recovery of gastrointestinal function has been assessed [Citation6]. We congratulate the authors on their very good results. They concluded that frailty not only increases the rate of patients with delayed recovery of gastrointestinal tract function but also the risk of postoperative ileus and anastomotic leakage. Similarly to previous reports, this study suggests that it is not the patients’ age but the presence of frailty which should be a matter of concern in colorectal surgery. As the authors state, a reevaluation of the indications for surgical intervention in elderly patients with colorectal cancer may be necessary. In our opinion, there may also be another benefit. The use of a modified Frailty Index (mFI) may lead to the more accurate selection of patients with high risk of perioperative mortality and for whom minimalization of surgical procedure may be beneficial. This can obviously be the next step in so-called personalized surgery. Currently a trend towards limiting extensive surgery is observed with the aim of reducing the risk of severe complications without comprising long-term outcomes [Citation7,Citation8].
As older patients form a large part of the overall population, frailty is a constantly increasing problem and it is impossible to completely eliminate it. However, efforts should be made to limit its incidence and to improve patients’ general condition before surgical treatment. The critical issue is proper nutrition and physical prehabilitation [Citation9].
Nowadays a patient’s age is no longer a contraindication for oncological treatment. Even the most extensive surgeries can be safely performed on the elderly [Citation10]. However, every patient should be evaluated individually and their preferences should be considered in order to choose the optimal mode of treatment.
DECLARATION OF INTEREST
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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