Surgery is the mainstay of treatment for most abdominal cancers. Although advancements in surgical techniques and perioperative care have made surgery safer for all patient groups, especially older patients are still at a higher risk for complications and functional decline.
This thesis started out by focusing on methods to improve preoperative risk assessment of older patients undergoing abdominal cancer surgery. We evaluated two preoperative frailty screening methods and showed that frailty assessment has additional value in predicting postoperative outcomes. We also addressed several potentially modifiable risk factors that could be targeted to improve outcomes. Declining muscle mass, poor physical performance and low physical activity levels can be used to identify at-risk patients. As surgery itself can be considered a modifiable risk factor, we also evaluated the evidence on different surgical treatment strategies in older patients with gastric cancer. We showed that data specifically in older patients are scarce and lacking in quality.
Finally, we focused on prehabilitation interventions involving nutritional enhancement and physical exercise to improve postoperative outcomes. We showed that prehabilitation is feasible for older patients if they are able to perform it at home and on their own terms. We argue that prehabilitation should be targeted on frail patients who have the most to gain from it.
Emerging evidence on the efficacy of prehabilitation is promising, but the optimal content and setting need to be further elucidated. High-quality research specifically in older patients regarding prehabilitation and surgical treatment options is required to continue improving outcomes for this population.
prof. Dr. B.C. van Munster