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

## TL;DR

This study shows that minimally invasive surgery for colorectal cancer in elderly patients can improve frailty over time, despite worse long-term survival in frail individuals.

## Contribution

The study provides new evidence that frailty can improve after successful minimally invasive surgery in elderly colorectal cancer patients.

## Key findings

- Frailty status significantly improved in 1-year recurrence-free patients after minimally invasive surgery.
- Frail patients had worse overall survival compared to non-frail patients.
- MIS was safely performed in frail elderly patients without increased complications.

## Abstract

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.

In this prospective observational study, 239 CRC patients aged ≥ 70 years 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.

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 1 year 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.

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.

This prospective study investigated the impact of MIS on frailty and outcomes in elderly CRC patients. While frail patients showed lower OS, MIS was safely performed. Among recurrence‐free patients, frailty status improved at 1 year, suggesting that curative surgery may offer not only oncologic benefits but also potential for frailty improvement.