Frailty as a Predictor of Postoperative Complications and Survival After Pancreatoduodenectomy



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Abstract

In the context of an aging population, the number of older and elderly patients requiring pancreatoduodenectomy is growing. Chronological age is not a reliable predictor of outcomes, whereas frailty syndrome, reflecting biological age, serves as a key risk factor for postoperative complications and adverse outcomes. Frailty, defined as a state of reduced physiological reserves, is a powerful independent predictor of postoperative outcomes. It is associated with a marked increase in the risk of 30-day mortality (by 1.5–2.5 times), the overall frequency, and development of serious complications, including those specific to pancreaticobiliary surgery. Frail patients have longer hospital stays and are significantly more likely to require discharge to rehabilitation facilities. In the long term, frailty negatively impacts overall survival, increases the risks of functional complications and deterioration in quality of life, and also reduces the likelihood of receiving adjuvant cancer therapy.

Various instruments are used to assess frailty (Fried phenotype, modified frailty index, clinical frailty scale); their integration into preoperative evaluation allows for improved risk stratification. Optimization strategies aimed at correcting identified deficits include preoperative prehabilitation (a combination of physical training, nutritional support, and psychological support), implementation of enhanced recovery protocols, multimodal analgesia, and multidisciplinary management involving a geriatrician and an intensivist. For patients over 80 years of age, the decision to proceed with surgery should be based not on chronological age but on a comprehensive assessment of biological age, functional reserves, and the feasibility of adjuvant therapy.

Routine frailty assessment and subsequent targeted, multi-step optimization of patient management within a multidisciplinary approach are essential prerequisites for improving the safety and outcomes of pancreatoduodenectomy in older patients.

About the authors

Vasiliy I. Egorov

Kazan State Medical University; Republican Clinical Oncology Dispensary named after Professor M.Z. Sigal

Author for correspondence.
Email: drvasiliy21@gmail.com
ORCID iD: 0000-0002-6603-1390
SPIN-code: 7794-4210

MD, Cand. Sci. (Medicine);

Russian Federation, Kazan; Kazan

Bulat F. Rakhmatullin

Republican Clinical Oncology Dispensary named after Professor M.Z. Sigal

Email: rachmatullin95@mail.ru
ORCID iD: 0009-0007-2761-3228
Russian Federation, Kazan

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