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Background <p>Older adults with lung cancer are increasingly being considered for video-assisted thoracoscopic surgery (VATS), including segmentectomy or lobectomy with lymph node assessment. Although VATS reduces surgical trauma compared with thoracotomy, it does not eliminate heterogeneity in physiological reserve, treatment tolerance, or postoperative recovery. Frailty may therefore complement conventional preoperative assessment, which is typically based on chronological age, comorbidity burden, pulmonary function, and cardiac risk.</p> Methods and main findings <p>This narrative review summarises the evidence on frailty assessment, perioperative outcomes, and prehabilitation strategies in patients undergoing lung cancer surgery, with a particular emphasis on VATS. Practical tools, such as the Clinical Frailty Scale and 4-metre gait speed, may support routine screening because they are brief, feasible, and clinically interpretable. More comprehensive approaches, including multidimensional frailty indices, nutritional assessment, sarcopenia evaluation, and comprehensive geriatric assessment, may be useful for selected patients. Available evidence suggests that frailty is associated with postoperative pulmonary complications, prolonged hospitalisation, non-home discharge, increased healthcare utilisation, and mortality after lung resection. However, direct evidence from frail patients with lung cancer undergoing VATS remains limited, and many recommendations are extrapolated from mixed thoracic surgery cohorts, studies of open lung resection, geriatric oncology, and non-thoracic surgical literature.</p> Conclusions <p>Frailty should be considered an actionable component of perioperative risk stratification, rather than a stand-alone criterion for determining surgical eligibility or the extent of VATS resection. Future studies in thoracic oncology should define optimal frailty assessment pathways and determine whether frailty-guided interventions can improve short-term recovery, long-term functional outcomes, tolerance of adjuvant therapy, and oncological outcomes after minimally invasive lung cancer surgery.</p>

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Frailty in patients undergoing video-assisted thoracoscopic surgery for lung cancer: a narrative review of assessment, outcomes and prehabilitation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Yiming Xu,
  • Mingming Cao,
  • Yuting Liu,
  • Xuyang Li,
  • Qiang Zhang

摘要

Background

Older adults with lung cancer are increasingly being considered for video-assisted thoracoscopic surgery (VATS), including segmentectomy or lobectomy with lymph node assessment. Although VATS reduces surgical trauma compared with thoracotomy, it does not eliminate heterogeneity in physiological reserve, treatment tolerance, or postoperative recovery. Frailty may therefore complement conventional preoperative assessment, which is typically based on chronological age, comorbidity burden, pulmonary function, and cardiac risk.

Methods and main findings

This narrative review summarises the evidence on frailty assessment, perioperative outcomes, and prehabilitation strategies in patients undergoing lung cancer surgery, with a particular emphasis on VATS. Practical tools, such as the Clinical Frailty Scale and 4-metre gait speed, may support routine screening because they are brief, feasible, and clinically interpretable. More comprehensive approaches, including multidimensional frailty indices, nutritional assessment, sarcopenia evaluation, and comprehensive geriatric assessment, may be useful for selected patients. Available evidence suggests that frailty is associated with postoperative pulmonary complications, prolonged hospitalisation, non-home discharge, increased healthcare utilisation, and mortality after lung resection. However, direct evidence from frail patients with lung cancer undergoing VATS remains limited, and many recommendations are extrapolated from mixed thoracic surgery cohorts, studies of open lung resection, geriatric oncology, and non-thoracic surgical literature.

Conclusions

Frailty should be considered an actionable component of perioperative risk stratification, rather than a stand-alone criterion for determining surgical eligibility or the extent of VATS resection. Future studies in thoracic oncology should define optimal frailty assessment pathways and determine whether frailty-guided interventions can improve short-term recovery, long-term functional outcomes, tolerance of adjuvant therapy, and oncological outcomes after minimally invasive lung cancer surgery.