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Page 6 of 9 Sioutas et al. Hepatoma Res 2020;6:4 I http://dx.doi.org/10.20517/2394-5079.2019.43 Table 2. Cohort studies on the association between frailty and postoperative adverse outcomes after hepatic resection

2017
Year
2016
2019
2016
2018
2019
2018
CONCLUSION
Itoh et al. [70]
Gani et al. [49]
Chen et al. [69]
Okabe et al. [71]
Authors
Kaibori et al. [53]
Tanaka et al. [64]
Louwers et al. [48]
USA
USA
USA
Japan
Japan
Japan
Japan
Country
71
217
154
814
143
1928
1900
10,300
patients
Number of
75.4 ± 4
60 ± 14.1
58 ± 12.2
78.3 ± 3.2
74.7 ± 4.5
64.6 ± 9.4
59.3 ± 13.4
58.8 ± 12.3
Age (years)*
stay; mFI: modified frailty index; N/A: not available; rFI: revised frailty index
rFI
G8
CFS
KCL
tool
Gait speed
5-point mFI
11-point mFI
11-point mFI
Frailty assessment
79%
80.4%
0% (0%)
0% (0%)
18.1% (N/A)
100% (100%)
69.5% (61.7%)
78.8% (69.1%)
Primary cancer (HCC)
assessment tools to evaluate postoperative outcomes after liver resection are summarized in Table 2 [72] .
Diagnosis (%)
0%
100%
100%
24.7%
20.3%
45.9%
Metastatic disease
0%
0%
0%
21%
36%
5.8%
Other
0.9%
19.6%
P = 0.18
P = 0.02
P = 0.02
P < 0.001
P < 0.001
P < 0.001
P = 0.002
Morbidity
P < 0.0001
N/A
N/A
P = 0.06
P = 0.02
P = 0.29
P < 0.001
P = 0.006
P = 0.048
Mortality
LOS
P = 0.11
P = 0.01
P = 0.01
P = 0.03
P = 0.08
P < 0.001
P < 0.001
P = 0.007
resection at a single-center in Japan [70] . The authors utilized receiver operating characteristic curves and determined that a cutoff of 1.1 m/s can accurately
complications were not significantly older than those without complications, individuals with a gait speed of ≤ 1.1 m/s were significantly older than those
an independent risk factor for severe postoperative complications, while age was not found to be a significant risk factor. In addition, the incidence of severe
*Values converted to mean and standard deviation based on Hozo et al. [72] . CFS: clinical frailty scale; FI: frailty index; G8: geriatric-8; HCC: hepatocellular carcinoma; KCL: kihon checklist; LOS: length of
a higher rate of complications compared to individuals with a gait speed > 1.1 m/s, while both groups had a mortality rate of 0%. Although patients with
Overall, several studies have proven the feasibility and safety of liver resection in the elderly; however, data do not unanimously support the concept that
chronological age constitutes a valid predictor of postoperative outcomes. Instead, frailty assessed by numerous tools seems to better predict postoperative
Gait speed, which is a component of the Fried’s Phenotype tool, has also been utilized to determine postoperative outcomes in patients undergoing liver
identify patients at risk of postoperative complications, based on multivariate analysis. Patients with a gait speed at or below 1.1 m/s had longer LOS and
differ between frail and non-frail patients, while the 90-day mortality rate was significantly higher in the frailty group [64] . Details of the studies utilizing frailty
impact of frailty on morbidity after liver resection for colorectal liver metastases using the CFS (frailty: CFS > 4). Multivariate analysis showed that frailty is
low serum albumin (≤ 4.0 g/dL) was also found to be an independent risk factor for postoperative complications [70] . Another Japanese study [71] assessed the
study groups. A prospective multicenter study from Japan sought to evaluate the impact of frailty, as measured by the KCL, on age-related morbidity after
postoperative complications, as well as LOS, were significantly higher in frail compared to non-frail patients. Nonetheless, mortality rates were 0% in both
found to be an independent risk factor of age-related events after liver resection, including major cardiopulmonary complications, delirium requiring medical
treatment, transfer to a rehabilitation facility, and dependency. However, the incidence of overall and major complications, 30-day mortality, and LOS did not
walking with a speed > 1.1 m/s. As age was not included in the multivariate model, meaningful conclusions cannot be easily deduced. On another note,
hepatic resection [64] . According to this phenotypic FI, patients are deemed frail when KCL is 8 or higher. Based on their multivariate analysis, frailty was