A retrospective study on the prediction of postoperative complications in elderly patients with lung cancer after robot-assisted lobectomy by mFI-11_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Jin ¹ , TIAN Zhenni ¹ , ZHOU Wensheng ¹ , TANG Xu ¹ , GOU Yunjiu ² ,  BAI Qizhou ²

1. The First Clinical Department of Gansu University of traditional Chinese medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R China;

Corresponding author：

BAI Qizhou, Email: baiqizhou1981@163.com

Keywords：

Modified frailty index; robot-assisted; elderly patients; lung cancer; postoperative complications

DOI：

10.7507/1007-4848.202507053

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Objective To explore the predictive value of the modified frailty index-11 (mFI-11) for postoperative complications in elderly lung cancer patients undergoing robot-assisted lobectomy. Methods Retrospective collection of clinical data from lung cancer patients aged ≥65 years who underwent robot-assisted lobectomy at the Department of Thoracic Surgery, Gansu Provincial Hospital, from January 2022 to June 2025. Based on the optimal grouping threshold of 0.27 in previous studies for the mFI-11 score, patients were divided into a frail and a non-frail group. Postoperative complications of the two groups were analyzed, and multivariate logistic regression was used to assess the relationship between mFI-11 and postoperative complications. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficiency of mFI-11 for postoperative complications. Results A total of 161 patients were included, with 77 males and 84 females, and an average age of (68.48±2.90) years. Among them, 103 (64.0%) patients were in the non-frail group and 58 (36%) in the frail group. Differences between the two groups in terms of independent functional status, hypertension requiring drug control, history of type 2 diabetes, history of chronic obstructive pulmonary disease, American Society of Anesthesiologists classification, and tumor staging were all statistically significant (P<0.05). The length of postoperative hospital stay in the frail group was longer than that in the non-frail group [5.50 (5.00, 8.25) d vs. 5.00 (4.00, 5.00) d, P<0.001]. The incidence rates of general respiratory diseases (25.9% vs. 8.7%), hypoproteinemia (15.5% vs. 4.9%), arrhythmia (12.1% vs. 1.9%), bronchopleural fistula (5.2% vs. 0.0%), transfer to ICU for severe complications (10.3% vs. 1.0%), and readmission within 30 days after discharge (12.1% vs. 1.9%) were all higher in the frail group compared to the non-frail group (P<0.05). Multivariate logistic regression analysis found that mFI-11 had a better predictive efficiency for postoperative complications: general respiratory diseases [area under the curve (AUC)=0.759], hypoproteinemia (AUC=0.723), arrhythmia (AUC=0.795), transfer to ICU for severe complications (AUC=0.713), and readmission within 30 days after discharge (AUC=0.702). Conclusion mFI-11 can effectively predict postoperative complications in elderly lung cancer patients undergoing robot-assisted lobectomy and can serve as an objective indicator for identifying high-risk elderly lung cancer patients.

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Li H, Li Q, Zheng Y, et al. Profiles and disparities of the global cancer and subtypes burden among adults aged 65 years and older: changing patterns in incidence and mortality, 1990-2021. Sci Bull (Beijing), 2025, 70(7): 1139-1151.
3.	Huang L, Li Z, Jian M, et al. Application of MFI-5 in severe complications and unfavorable outcomes after radical resection of colorectal cancer. World J Surg Oncol, 2023, 21(1): 307.
4.	Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg, 2010, 210(6): 901-908.
5.	Xu SJ, Lin LQ, Chen C, et al. Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma. Ann Transl Med, 2022, 10(4): 161.
6.	郭嘉琪, 吴镜湘, 姚海霞, 等. 术前衰弱对老年食管癌患者术后并发症影响的回顾性队列研究. 中国胸心血管外科临床杂志, 2023, 30(8): 1169-1174.Guo JQ, Wu JX, Yao HX, et al. Effect of preoperative frailty on postoperative complications in elderly patients with esophageal cancer: a retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(8): 1169-1174.
7.	Catelli C, Corzani R, Zanfrini E, et al. Robotic-assisted (RATS) versus video-assisted (VATS) lobectomy: a monocentric prospective randomized trial. Eur J Surg Oncol, 2023, 49(12): 107256.
8.	Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet, 2019, 394(10206): 1365-1375.
9.	Araújo-Andrade L, Rocha-Neves JP, Duarte-Gamas L, et al. Prognostic effect of the new 5-factor modified frailty index in patients undergoing carotid endarterectomy with regional anesthesia: a prospective cohort study. Int J Surg, 2020, 80: 27-34.
10.	Dent E, Martin FC, Bergman H, et al. Management of frailty: opportunities, challenges, and future directions. Lancet, 2019, 394(10206): 1376-1386.
11.	Chen X, Dang Y, Zhang Q, et al. MFI-11 in Chinese elderly esophageal cancer patients with postoperative adverse outcomes. BMC Geriatr, 2024, 24(1): 677.
12.	袁婷婷, 阿迪莱·库热西, 米吉提·麦麦提, 等. 5因素改良衰弱指数预测食管癌术后严重并发症的价值. 浙江医学, 2025, 47(4): 403-409.Yuan TT, Adilai Kurexi, Mijiti Maimaiti, et al. Predictive value of the 5-factor modified frailty index for severe postoperative complications following esophageal cancer surgery. Zhejiang Med J, 2025, 47(4): 403-409.
13.	Mather S, Prince L, Bucher O, et al. The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy. J Geriatr Oncol, 2022, 13(5): 654-661.
14.	Iacobescu R, Boiculese L, Lunguleac T, et al. Preoperative frailty as the strongest predictor of postoperative adverse events burden in patients with operable non-small cell lung cancer: a retrospective analysis. Expert Rev Respir Med, 2025, 19(5): 475-481.
15.	Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg, 2011, 142(4): 740-746.
16.	Khan AH, Heintzelman KE, Fletcher DM, et al. Modified frailty index-11 (mFI-11) measured frailty as a predictor of postoperative outcomes in Parkinson's disease patients undergoing deep brain stimulation: a national inpatient sample analysis. J Clin Neurosci, 2025, 138: 111386.
17.	Gajjar AA, Chen JY, Prabhala T, et al. National assessment of frailty impact on endovascular mechanical thrombectomy for minor to moderately severe large vessel occlusions per NIHSS. Interv Neuroradiol, 2025. [Epub ahead of print].
18.	鲁燕, 程浩, 陈永权. 改良衰弱指数联合麻醉分级对老年腹腔镜手术患者麻醉相关不良事件的预测价值. 新疆医科大学学报, 2024, 47(6): 849-853.Lu Y, Cheng H, Chen YQ. Predictive value of modified frailty index (mFI) combined with anesthesia grading for anesthesia-related adverse events in elderly patients undergoing laparoscopic surgery. J Xinjiang Med Univ, 2024, 47(6): 849-853.
19.	马海瑞. 5项改良衰弱指数(5-mFI)与妇科老年患者腹部手术术后并发症的回顾性研究. 北京协和医学院, 2023.Ma HR. A retrospective study on the relationship between 5 modified frailty index (5-mFI) and postoperative complications of gynecological elderly patients undergoing abdominal surgery. Peking Union Medical College, 2023.
20.	Tsiouris A, Hammoud ZT, Velanovich V, et al. A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res, 2013, 183(1): 40-46.
21.	Xu ZY, Hao XY, Wu D, et al. Prognostic value of 11-factor modified frailty index in postoperative adverse outcomes of elderly gastric cancer patients in China. World J Gastrointest Surg, 2023, 15(6): 1093-1103.
22.	黄宇红. ERAS理念下围手术期营养管理联合肺康复训练对肺癌根治术后康复效果的影响. 西藏医药, 2024, 45(3): 98-100.Huang YH. The influence of perioperative nutritional management combined with pulmonary rehabilitation training under the ERAS concept on the rehabilitation effect after radical resection of lung cancer. Tibetan Med J, 2024, 45(3): 98-100.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Li H, Li Q, Zheng Y, et al. Profiles and disparities of the global cancer and subtypes burden among adults aged 65 years and older: changing patterns in incidence and mortality, 1990-2021. Sci Bull (Beijing), 2025, 70(7): 1139-1151.
3. Huang L, Li Z, Jian M, et al. Application of MFI-5 in severe complications and unfavorable outcomes after radical resection of colorectal cancer. World J Surg Oncol, 2023, 21(1): 307.
4. Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg, 2010, 210(6): 901-908.
5. Xu SJ, Lin LQ, Chen C, et al. Textbook outcome after minimally invasive esophagectomy is an important prognostic indicator for predicting long-term oncological outcomes with locally advanced esophageal squamous cell carcinoma. Ann Transl Med, 2022, 10(4): 161.
6. 郭嘉琪, 吴镜湘, 姚海霞, 等. 术前衰弱对老年食管癌患者术后并发症影响的回顾性队列研究. 中国胸心血管外科临床杂志, 2023, 30(8): 1169-1174.Guo JQ, Wu JX, Yao HX, et al. Effect of preoperative frailty on postoperative complications in elderly patients with esophageal cancer: a retrospective cohort study. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(8): 1169-1174.
7. Catelli C, Corzani R, Zanfrini E, et al. Robotic-assisted (RATS) versus video-assisted (VATS) lobectomy: a monocentric prospective randomized trial. Eur J Surg Oncol, 2023, 49(12): 107256.
8. Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet, 2019, 394(10206): 1365-1375.
9. Araújo-Andrade L, Rocha-Neves JP, Duarte-Gamas L, et al. Prognostic effect of the new 5-factor modified frailty index in patients undergoing carotid endarterectomy with regional anesthesia: a prospective cohort study. Int J Surg, 2020, 80: 27-34.
10. Dent E, Martin FC, Bergman H, et al. Management of frailty: opportunities, challenges, and future directions. Lancet, 2019, 394(10206): 1376-1386.
11. Chen X, Dang Y, Zhang Q, et al. MFI-11 in Chinese elderly esophageal cancer patients with postoperative adverse outcomes. BMC Geriatr, 2024, 24(1): 677.
12. 袁婷婷, 阿迪莱·库热西, 米吉提·麦麦提, 等. 5因素改良衰弱指数预测食管癌术后严重并发症的价值. 浙江医学, 2025, 47(4): 403-409.Yuan TT, Adilai Kurexi, Mijiti Maimaiti, et al. Predictive value of the 5-factor modified frailty index for severe postoperative complications following esophageal cancer surgery. Zhejiang Med J, 2025, 47(4): 403-409.
13. Mather S, Prince L, Bucher O, et al. The impact of the modified frailty index on clinical outcomes for patients with stage IV non-small cell lung cancer receiving chemotherapy. J Geriatr Oncol, 2022, 13(5): 654-661.
14. Iacobescu R, Boiculese L, Lunguleac T, et al. Preoperative frailty as the strongest predictor of postoperative adverse events burden in patients with operable non-small cell lung cancer: a retrospective analysis. Expert Rev Respir Med, 2025, 19(5): 475-481.
15. Cerfolio RJ, Bryant AS, Skylizard L, et al. Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms. J Thorac Cardiovasc Surg, 2011, 142(4): 740-746.
16. Khan AH, Heintzelman KE, Fletcher DM, et al. Modified frailty index-11 (mFI-11) measured frailty as a predictor of postoperative outcomes in Parkinson's disease patients undergoing deep brain stimulation: a national inpatient sample analysis. J Clin Neurosci, 2025, 138: 111386.
17. Gajjar AA, Chen JY, Prabhala T, et al. National assessment of frailty impact on endovascular mechanical thrombectomy for minor to moderately severe large vessel occlusions per NIHSS. Interv Neuroradiol, 2025. [Epub ahead of print].
18. 鲁燕, 程浩, 陈永权. 改良衰弱指数联合麻醉分级对老年腹腔镜手术患者麻醉相关不良事件的预测价值. 新疆医科大学学报, 2024, 47(6): 849-853.Lu Y, Cheng H, Chen YQ. Predictive value of modified frailty index (mFI) combined with anesthesia grading for anesthesia-related adverse events in elderly patients undergoing laparoscopic surgery. J Xinjiang Med Univ, 2024, 47(6): 849-853.
19. 马海瑞. 5项改良衰弱指数(5-mFI)与妇科老年患者腹部手术术后并发症的回顾性研究. 北京协和医学院, 2023.Ma HR. A retrospective study on the relationship between 5 modified frailty index (5-mFI) and postoperative complications of gynecological elderly patients undergoing abdominal surgery. Peking Union Medical College, 2023.
20. Tsiouris A, Hammoud ZT, Velanovich V, et al. A modified frailty index to assess morbidity and mortality after lobectomy. J Surg Res, 2013, 183(1): 40-46.
21. Xu ZY, Hao XY, Wu D, et al. Prognostic value of 11-factor modified frailty index in postoperative adverse outcomes of elderly gastric cancer patients in China. World J Gastrointest Surg, 2023, 15(6): 1093-1103.
22. 黄宇红. ERAS理念下围手术期营养管理联合肺康复训练对肺癌根治术后康复效果的影响. 西藏医药, 2024, 45(3): 98-100.Huang YH. The influence of perioperative nutritional management combined with pulmonary rehabilitation training under the ERAS concept on the rehabilitation effect after radical resection of lung cancer. Tibetan Med J, 2024, 45(3): 98-100.

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