Impact of preoperative frailty assessment on peri-operative complications and cancer related outcomes in advanced stage endometrial cancer

Objective The impact of pre-operative frailty on outcomes in patients with endometrial cancer is not well studied. The primary aim of this study was to assess the association between preoperative frailty scores and postoperative complications in patients with advanced-stage endometrial cancer. Methods This is a retrospective cohort study of patients who underwent hysterectomy for advanced-stage endometrial cancer at a single institution. Frailty was defined using the modified frailty index (mFI ≥ 2). Complications were measured with the Comprehensive Complication Index (CCI). Results A total of 62 were included; 17 met criteria for frail (F) based on mFI. In the non-frail (NF) cohort, 11 patients underwent open surgery vs. 4 in F. There were 34 NF patients in the MIS group, and 13 in F. Complications occurred in 29.4% F vs. 28.9% NF patients, p = 1.00), in the open surgery subgroup (50.0% F vs. 45.5% NF, p = 1.00) and in the minimally invasive surgery subgroup (23.1% F vs. 23.5% NF, p = 1.00). Those with complications had similar median CCI scores (22.6F vs. 24.2 NF, p = 0.84). Median days to adjuvant therapy were similar (39F vs. 43 NF, p = 0.32). Progression free survival (PFS) and overall survival (OS) was similar between groups. Conclusion Frailty was not associated with increased postoperative complication rate or worse survival in advanced endometrial cancer. Endometrial cancer surgery is largely performed minimally invasively which may be a factor that mitigates the adverse impact of frailty. Our small sample size limits interpretation: larger, multi-institutional studies are needed to determine whether surgical approach offsets the impact of frailty in this population.