Frailty assessment tools and geriatric assessment in older patients with hepatobiliary and pancreatic malignancies.
BACKGROUND
The majority of patients with hepatobiliary and pancreatic (HBP) malignancies are older than 65 years. Due to the heterogeneity of this older population, decisions regarding surgical treatment cannot rely solely on treatment guidelines, but have to take into account patient frailty, geriatric impairments and resilience as well as patient preferences. In the few studies of older patients with HBP malignancies that have included a preoperative geriatric assessment (GA), frailty and elements from the GA such as reduced functional status have emerged as powerful predictors of postoperative morbidity and mortality, length of stay, type of treatment received and survival. A GA is a systematic evaluation of functional status, comorbidities, polypharmacy, cognition, nutritional status, emotional status, and social support.


MATERIALS AND METHODS
A Pubmed search identifying clinical studies investigating the association between frailty, GA and outcomes in patients with HBP malignancies.


RESULTS
A total of 20 studies were included in this review. For HBP malignancies, the evidence linking frailty and GA variables to negative outcomes is limited, but generally shows that frailty, functional dependency, comorbidity, and sarcopenia predict postoperative complications and survival.


CONCLUSION
Although scarcely investigated, frailty and elements from a GA seem to be associated with negative short- and long-term treatment outcomes in older patients with HBP malignancies. Future studies should investigate the impact of geriatric interventions and prehabilitation on outcomes.
['Rostoft|Siri|S|', 'van Leeuwen|Barbara|B|']
D000368:Aged D001661:Biliary Tract Neoplasms D000066491:Clinical Decision-Making D015897:Comorbidity D004644:Emotions D016330:Frail Elderly D000073496:Frailty D015577:Geriatric Assessment D006801:Humans D008113:Liver Neoplasms D009752:Nutritional Status D010190:Pancreatic Neoplasms D012944:Social Support
Frailty Assessment tools Geriatric assessment Cancer Hepatobiliary disorders Older adults Preoperative assessment