Prognostic Value of the Clinical Frailty Scale for Outcomes After Minimally Invasive Rectal Cancer Surgery in Older Patients

Background and Objectives: We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients. Methods: This single-center retrospective cohort study included patients aged ≥ 75 years with pathological stage I–III disease after R0 resection who underwent surgery within September 2012–2022, stratified by CFS score. Univariate and multivariate analyses assessed risk factors for postoperative complications. Cox proportional hazards models identified prognostic factors for overall survival (OS) and disease-specific survival (DSS). Results: Among 109 patients (median age: 78 [interquartile range, 76–82]; 65.1% male), the CFS 5–7 group (n = 17) had a higher stoma creation rate (70.6% vs. 43.5%; p = 0.063) than the CFS 1–4 group (n = 92), and none in this group underwent lateral pelvic lymph node dissection. No independent risk factors were identified for postoperative complications with Clavien–Dindo grade ≥ II. CFS 5–7 was independently associated with worse OS (hazard ratio [HR] = 10.073; p < 0.001) and DSS (HR = 9.135; p = 0.003), and 3-year OS (63.6% vs. 85.6%, p < 0.001) and DSS (74.3% vs. 90.7%, p = 0.035) were significantly poorer. Conclusions: CFS provides a simple and effective preoperative assessment tool for evaluating patient frailty that significantly influences long-term outcomes in patients undergoing minimally invasive rectal cancer surgery.