The role of preoperative frailty assessment in patients affected by gynecological cancer: a narrative review

Abstract

The following article aims to highlight the importance of the assessment of frailty in patients affected by gynecological cancer and to discuss current data available on scores commonly used to predict adverse postoperative outcomes and overall survival in this group of patients. A narrative review was performed in Medline (PubMed) and Embase database until February 28, 2022. This study includes randomized and observational studies about patients undergoing non-emergent surgery for gynecological malignancies with preoperative frailty assessment. Fourteen studies, for a total of 85957 women, were included. The Modified Frailty Index (mFI) is the most commonly used tool for definition of frail patient. Results highlighted that frail patients had lower disease-free survival rates and overall survival rates than non-frail patients. Additionally, frail patients were more at risk of developing 30-day postoperative complications, non-home discharge and Intensive Care Unit admission than the other group. In gynecologic oncology, the assessment of the state of women's frailty is fundamental to predict adverse outcomes and to customize treatment strategies. Modified Frailty Index is the most used tool to assess the frailty state of gynecologic oncologic patients. We advise that this index should be part of the patients' standard evaluation and that it may be used in the daily practice to aid in shared decision making for tailored therapeutic strategies. In this manuscript we provide an update on the importance of the use of preoperative frailty scores to predict complications among patients treated for gynecological cancer.

Novel Insights into Molecular Mechanisms of Endometrial Diseases

“…These results suggest that it would be useful to perform a more detailed molecular analysis especially in high-risk ECs, which represent a subclass with complex and heterogeneous characteristics, refining therapeutic management in clinical practice [ 21 , 23 , 24 , 25 , 26 ]. Furthermore, EC generally affects patients with a higher rate of comorbidity, elderly or obese, the assessment of the state of women’s frailty is fundamental to customize treatment strategies and reducing the morbidity rate therapy-related [ 27 , 28 , 29 ].…”

Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

“…In addition, most patients with EC have personal risk factors, such as obesity, diabetes or metabolic syndrome that contribute to increased surgery-related complications. Tailored surgery and no overtreatment could reduce the incidence of these adverse events [29][30][31][32][33][34][35].…”

Meigs syndrome secondary to adult granulosa cell tumor with elevated CA125 levels: a case report

“…In the first and second-line adjuvant chemotherapy in patients affected by ovarian cancer, the combined use of bevacizumab, an antiangiogenetic agent, significantly improves progression-free survival [21]. To achieve a personalized therapeutic strategy, it is necessary to preoperatively evaluate the conditions of gynecologic cancer patients [22].…”