Modified frailty index and systemic immune-inflammation enable biological risk stratification in geriatric colorectal cancer surgery

The global demographic shift toward an aging population has significantly increased the incidence of colorectal cancer (CRC) among older adults. However, chronological age alone is an insufficient predictor of surgical risk and oncological outcomes. A recent study published by Qi et al in World Journal of Gastrointestinal Oncology identifies the modified frailty index and the systemic immune-inflammation index as critical indices for predicting postoperative complications and recurrence-free survival. This editorial provides an in-depth analysis of how frailty and systemic inflammation intersect to dictate the clinical trajectory of geriatric CRC patients. We discuss the biological mechanisms of immunosenescence, the impact of physiological reserve depletion, and the necessity of incorporating multidimensional indices into routine clinical practice to facilitate personalized prehabilitation and optimized perioperative care.