{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:46:39Z","timestamp":1792082799927,"version":"4.4.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"\n Objective<\/jats:title>\n This study aimed to identify factors associated with early postoperative loss of independence (LOI) and assess the utility of preoperative handgrip strength (HGS) and frailty evaluation among patients undergoing colorectal cancer (CRC) resection.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We prospectively evaluated HGS, frailty, and depression among patients with CRC enrolled at our center from February 2024 to February 2025. The associations between HGS and perioperative outcomes were analyzed. Subsequently, a predictive model for postoperative LOI was developed based on the above three variables.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 258 patients with CRC were enrolled, and 60 (23.3%) developed early postoperative LOI. Patients with preoperative low HGS had shorter operative time (\n p<\/jats:italic>\n \u00a0=\u00a00.020) and increased postoperative complications (\n p<\/jats:italic>\n \u00a0=\u00a00.002), particularly pneumonia (\n p<\/jats:italic>\n \u00a0=\u00a00.031). Delayed first defecation (\n p<\/jats:italic>\n \u00a0=\u00a00.008), prolonged time to full oral nutrition (\n p<\/jats:italic>\n \u00a0=\u00a00.024), and extended length of stay (\n p<\/jats:italic>\n \u00a0=\u00a00.002) were also observed in these patients. Multivariate analysis showed that American Society of Anesthesiologists (ASA) score \u22653 [odds ratio (OR) = 2.556,\n p<\/jats:italic>\n \u00a0=\u00a00.019], preoperative moderate frailty (OR\u00a0=\u00a09.504,\n p<\/jats:italic>\n \u00a0=\u00a00.002), and low HGS (OR = 2.452,\n p<\/jats:italic>\n \u00a0=\u00a00.01) were adverse predictors of LOI. The receiver operating characteristic (ROC) curve revealed a moderate predictive performance of the model, with an area under the curve (AUC) of 0.740 [95% confidence interval (CI): 0.657\u20130.823].\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Patients with low HGS are prone to increased postoperative complications and delayed postoperative recovery. Postoperative LOI is independently correlated with ASA score \u2265 3, low HGS, and moderate frailty. Therefore, assessment of frailty and HGS prior to radical resection of CRC facilitates preoperative risk stratification.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fonc.2026.1878444","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:14:13Z","timestamp":1782882853000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of preoperative handgrip strength and frailty on early postoperative loss of independence in patients with colorectal cancer"],"prefix":"10.3389","volume":"16","author":[{"given":"Dongqin","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Nursing, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"He","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqing","family":"Qing","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel","year":"2022","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/s1470-2045(18)30646-6","article-title":"Surgical treatment and survival from colorectal cancer in Denmark, England, Norway, and Sweden: a population-based study","volume":"20","author":"Benitez Majano","year":"2019","journal-title":"Lancet Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2018.08.003","article-title":"Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer","volume":"44","author":"Montroni","year":"2018","journal-title":"Eur J Surg Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.4430","article-title":"Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM)","volume":"91","author":"Tekkis","year":"2004","journal-title":"Br J Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2022.11.095","article-title":"Surgical and non-surgical complications after colorectal cancer surgery in older patients; time-trends and age-specific differences","volume":"49","author":"van der Hulst","year":"2023","journal-title":"Eur J Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1177\/0148607113514113","article-title":"Handgrip strength and associated factors in hospitalized patients","volume":"39","author":"Guerra","year":"2015","journal-title":"Jpen J Parenter Enteral Nutr"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afae052","article-title":"The conceptual definition of sarcopenia: Delphi consensus from the Global Leadership Initiative in Sarcopenia (GLIS)","volume":"53","author":"Kirk","year":"2024","journal-title":"Age Ageing"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-023-01376-3","article-title":"Risk factors of \"loss of independence\" in elderly patients who received gastrectomy for gastric cancer","volume":"26","author":"Sakurai","year":"2023","journal-title":"Gastric Cancer"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.06.017","article-title":"Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society","volume":"215","author":"Chow","year":"2012","journal-title":"J Am Coll Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2016.00150","article-title":"The gap between clinical research and standard of care: a review of frailty assessment scales in perioperative surgical settings","volume":"4","author":"Stoicea","year":"2016","journal-title":"Front Public Health"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000001448","article-title":"Influence of depression on recovery after major noncardiac surgery: a prospective cohort study","volume":"262","author":"Orri","year":"2015","journal-title":"Ann Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.12.085","article-title":"Impact of preoperative anxiety and depression on quality of life before and after resection of hepatocellular carcinoma","volume":"246","author":"Lee","year":"2019","journal-title":"J Affect Disord"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s12282-023-01475-0","article-title":"Association of psychological distress with arm morbidity symptoms in breast cancer survivors: outcomes from the use of PHQ-9 and GAD-7 questionnaires","volume":"30","author":"Yusof","year":"2023","journal-title":"Breast Cancer"},{"key":"B14","doi-asserted-by":"publisher","first-page":"100557","DOI":"10.1016\/j.bj.2022.08.003","article-title":"Association of preoperative frailty and postoperative delirium in older cancer patients undergoing elective abdominal surgery: a prospective observational study in Taiwan","volume":"46","author":"Tsai","year":"2023","journal-title":"BioMed J"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2022.06.001","article-title":"Impact of frailty on oncological outcomes in patients undergoing surgery for colorectal cancer - a systematic review and meta-analysis","volume":"21","author":"Davey","year":"2023","journal-title":"Surgeon"},{"key":"B16","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afl041","article-title":"Validity and reliability of the edmonton frail scale","volume":"35","author":"Rolfson","year":"2006","journal-title":"Age Ageing"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-016-5253-7","article-title":"A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair","volume":"31","author":"Chimukangara","year":"2017","journal-title":"Surg Endosc"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1037\/t02366-000","article-title":"Functional evaluation: the Barthel index","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md State Med J"},{"key":"B20","article-title":"Stroke rehabilitation: analysis of repeated Barthel index measures","volume":"60","author":"Granger","year":"1979","journal-title":"Arch Phys Med Rehabil"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.03.022","article-title":"Muscle mass, density, and strength are necessary to diagnose sarcopenia in patients with gastric cancer","volume":"241","author":"Lin","year":"2019","journal-title":"J Surg Res"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-08520-8","article-title":"Handgrip strength predicts postoperative pneumonia after thoracoscopic-laparoscopic esophagectomy for patients with esophageal cancer","volume":"27","author":"Kurita","year":"2020","journal-title":"Ann Surg Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11237129","article-title":"Impact of preoperative handgrip strength on postoperative outcome after radical gastrectomy for gastric cancer patients","volume":"11","author":"Matsui","year":"2022","journal-title":"J Clin Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.2147\/cia.S194543","article-title":"Grip strength: an indispensable biomarker for older adults","volume":"14","author":"Bohannon","year":"2019","journal-title":"Clin Interv Aging"},{"key":"B26","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1186\/s12967-025-06239-2","article-title":"Assessment of muscle fatigability using isometric repetitive handgrip strength in frail older adults. A cross-sectional study","volume":"23","author":"Kapan","year":"2025","journal-title":"J Transl Med"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-015-0554-4","article-title":"Impact of preoperative hand grip strength on morbidity following gastric cancer surgery","volume":"19","author":"Sato","year":"2016","journal-title":"Gastric Cancer"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3390\/nu14183816","article-title":"Sex and diet-related disparities in low handgrip strength among young and middle-aged Koreans: findings based on the Korea National Health and Nutrition Examination Survey (KNHANES) from 2014 to 2017","volume":"14","author":"Kim","year":"2022","journal-title":"Nutrients"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000005720","article-title":"Domains of frailty predict loss of independence in older adults after noncardiac surgery","volume":"278","author":"Goeddel","year":"2023","journal-title":"Ann Surg"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2015.04.079","article-title":"ASA class is a reliable independent predictor of medical complications and mortality following surgery","volume":"18","author":"Hackett","year":"2015","journal-title":"Int J Surg"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1200\/jco.22.02195","article-title":"Predicting functional recovery and quality of life in older patients undergoing colorectal cancer surgery: real-world data from the International GOSAFE Study","volume":"41","author":"Montroni","year":"2023","journal-title":"J Clin Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/sla.0000000000002436","article-title":"Postoperative delirium as a target for surgical quality improvement","volume":"268","author":"Berian","year":"2018","journal-title":"Ann Surg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1878444\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T05:14:14Z","timestamp":1782882854000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1878444\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":32,"alternative-id":["10.3389\/fonc.2026.1878444"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1878444","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"1878444"}}