https://doi.org/10.4081/sigaf.2026.34
Buying time yields a free lunch. The role of preoperative optimization in the management of frail elderly patients with complicated colorectal adenocarcinoma: a case report
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Published: 8 September 2026
The coexistence of advanced age and frailty represents a potentially explosive combination that is becoming increasingly prevalent across Western countries. Frail older patients face high perioperative risks, complications, and functional decline, thus affecting recovery and outcomes following emergency surgery. We report the case of a 78-year-old frail female (Performance Status - Eastern Cooperative Oncology Group [PS-ECOG] 3, Clinical Frailty Scale [CFS] 4, Charlson Comorbidity Index [CCI] 6) with subocclusive adenocarcinoma of the hepatic flexure to highlight the value of preoperative optimization and elective surgery. Through home nutritional support, prehabilitation, intravenous (IV) iron, and metabolic stabilization, she underwent elective surgery 14 days after initial evaluation. This case demonstrates that a proper preoperative assessment, even within a short optimization window, followed by tailored preoperative strategies can safely enable major elective surgery in frail elderly patients, reduce perioperative risk, and improve outcomes, thus avoiding emergency laparotomy and its potential complications. The integration of geriatric assessment and enhanced recovery principles may serve as a model for the surgical-geriatrics interface in managing complex oncogeriatric cases requiring timely and effective interventions.
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CRediT authorship contribution
Alessandro Bergna: conceptualization, design, writing – original draft; Maria Mauri: writing – original draft, critical revision; Vera Rebasti: data collection, writing – original draft; Andrea Rusconi, Ettore Lillo, Leonardo Lenisa, Jacques Megevand: critical revision; Alessandro Bergna, Massimo Amboldi: case management. All authors have read and approved the final version of the manuscript and agreed to be accountable for all aspects of the work.
Data Availability Statement
Data that support the findings of this study are available on request from the corresponding author.
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