Globally, gastrointestinal (GI) cancer burden is higher in Asian populations. Asian Americans are commonly aggregated into a single category, potentially masking disparities. This study compared mortality from GI cancers among Asian American subpopulations to White patients. Mortality data (2018–2023) was collected from Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research which included White and Asian subgroups: Indian Americans, Chinese, Filipino, Japanese, Korean, and Vietnamese. Deaths from all causes and GI cancers (esophagus, stomach, small intestine, colon, rectal, anal, hepatobiliary, and pancreas) were analyzed. Proportional mortality (PM) was calculated as cancer deaths divided by all deaths. During the study period, there were 425,162 total deaths and 34,167 deaths from GI cancers among the Asian American population in the United states, compared to 14,066,027 total deaths and 713,638 deaths from GI cancers among the White population (PM 8.0% vs. 5.1%, p < 0.001). Among Asian American women, the largest disparities in PM were observed in patients with stomach (1.0% vs. 0.2%, p < 0.001) and hepatobiliary cancers (1.7% vs. 0.7%), p < 0.001) relative to White women. Similarly, among Asian American men, the largest disparities were also observed in stomach (1.1% vs. 0.3%, p < 0.001) and hepatobiliary cancers (2.7% vs. 1.1%, p < 0.001). Anal cancers was the only GI cancer for which Asian American women (0.02% vs. 0.07%) and men (0.02% vs. 0.04%) had lower PMs compared to the White population. Asian Americans experience greater mortality from GI cancers compared to white patients. The largest differences in PM were observed in stomach and hepatobiliary cancers across both male and female populations and all age categories. Culturally competent strategies that tailor screening guidelines and cancer prevention efforts to the unique risk profiles of Asian American subpopulations are desperately needed.

BackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is well established for mucinous cancers with peritoneal dissemination. Its role for non-mucinous tumors is less defined. This study compares outcomes between mucinous and non-mucinous cancer patients undergoing CRS-HIPEC to better understand therapeutic impact.MethodsA prospectively maintained database of CRS-HIPEC patients at an academic tertiary referral center from 2011-2023 was analyzed, including patients with appendiceal, colorectal, gastric, ovarian tumors, and soft tissue sarcomas. Survival outcomes were assessed using Kaplan Meier curves and multivariate Cox-proportional hazards models.ResultsAmong 195 patients, 55 (28%) had non-mucinous cancers and 140 (72%) mucinous tumors. The non-mucinous group had lower PCI (median 9 vs 14, P < 0.0001) was more frequently high grade (43.6% vs 22.9%, P = 0.004) with lymph node metastases (65.5% vs 17.1%, P < 0.0001). Length of stay, 30-day readmissions, and Clavien Dindo scores were similar between groups. There was no significant difference in overall (aHR 1.67, 95% CI 0.84-3.33) or cancer-specific survival (aHR 1.34, 95% CI 0.60-3.00) between groups. Non-mucinous patients did have a higher risk of cancer progression (aHR 2.50 95% CI 1.43-4.36), although this was primarily driven by differences in the appendiceal subgroup and was not seen in colorectal cancer patients.DiscussionDespite differential loco-regional features, non-mucinous cancer patients had similar survival after CRS-HIPEC. Differences in progression were primarily seen in those with appendiceal cancers, not colorectal tumors. These findings support the use of CRS-HIPEC across histologic subtypes, contributing to prognostication and risk-stratification for patients with differing cancer histopathology.

The Appalachian region consists of over 26 million Americans, of whom almost 2.5 million live in rural areas. Various social determinants of health including but not limited to rural living conditions and geographic isolation, food insecurity, and low income contribute to disparate health outcomes compared to the rest of the country. Obesity, hypertension, diabetes, stroke, and chronic heart diseases are all more prevalent in Appalachia. These comorbidities, combined with the aforementioned social vulnerabilities, place the Appalachian population at increased risk of higher cancer incidence and poorer outcomes. Lung, cervical, breast, penile, prostate, colorectal, and head and neck cancers are all shown to have higher rates and poorer outcomes within Appalachia relative to the country. Advanced staged colorectal cancer patients are a unique population that may be even further impacted by the social inequities in Appalachia, given the resource-intensive and multi-disciplinary approach required for effective treatment. Unfortunately, there is a dire lack of investigation into the incidence and outcomes of advanced stage colorectal cancer in Appalachian residents. This review summarizes the existing literature on disparate cancer outcomes in the Appalachian population, with a focus on advanced stage colorectal cancer. We also propose various approaches that could decrease malignancy rates and improve outcomes, such as dietary adjustments, screening tools, and public educational endeavors. We also acknowledge the role high-volume centers can play in working towards accessible care and the potential for collaborations between large institutions within Appalachian regions to spur the change that is greatly needed.

Objectives:Peritoneal mesothelioma (PM) shares features with genitourinary (GU) malignancies, including histologic appearance, embryologic origin and genetic predispositions. However, data on their co-occurrence are limited. The study presents a case series of PM patients with associated GU malignancies and explores outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Methods:A prospectively maintained CRS-HIPEC database from a tertiary referral center (2011-2024) was reviewed. Demographics, tumor characteristics and outcomes were compared between PM patients with and without GU malignancies (including gynecologic and urologic cancers). Results:Among 237 CRS-HIPEC patients, 8/17 patients with PM were found to have another GU malignancy (median age 52.8, 62.5 % male). This included renal cell carcinoma, prostate cancer, ovarian tumors and cervical carcinoma. Most GU malignancies were diagnosed before PM (5/8), two were diagnosed post-CRS-HIPEC, and one synchronously. Three patients reported asbestos exposure; two had BAP1 mutations. Compared to those without GU malignancies, affected patients tended to have higher PCI (19.8 vs. 14.3) and poorer 3-year survival (62.5 vs. 100 %). Conclusions:GU malignancy is common among PM patients undergoing CRS-HIPEC and could represent a higher-risk subgroup. These findings raise the hypothesis of a potential association between PM and GU malignancy. Shared origins, oncogenesis of similar cell types, environmental exposures or genetic predispositions may contribute and warrant further investigation.

824 Background: Timely detection of appendiceal malignant tumors is a clinical priority because of the propensity for this malignancy to metastasize to the peritoneal cavity. Up to one in every 2 patients with this rare tumor type will present with distant metastatic disease, owing to there being no standardized screening tests for early detection of primary appendiceal cancers. Case reports have pointed to broad/non-specific symptoms of patients diagnosed with appendiceal malignant tumors, yet information is needed from large cohorts to support prompt/accurate clinical diagnoses. Methods: We analyzed data from patients with a pathologically-confirmed first primary appendiceal malignant tumor (AC) who prospectively enrolled in the nation-wide Genetics of Appendix Cancer [GAP] clinical cohort study (Clinicaltrials.gov, NCT05734430) between November 2022 and May 2024. The primary outcome was presenting symptoms that led to AC diagnosis. Symptom effects and interactions with diagnosis age/year, sex, body mass index (BMI), and tumor histology, were quantified with negative binomial regression models and presented as incidence rate ratios (IRRs) and 95% confidence intervals. Results: Of the 352 patients included in our analyses (median [IQR] age, 51.0 [42-59] yr), 77.6% were female and 96.6% had an adenocarcinoma histology. Seventy-seven percent of patients (n=270) reported one or more presenting symptoms, of whom 55.2% (n=149) experienced these symptoms for 3+ months prior to diagnosis. On average, patients reported 3 symptoms (mean: 2.9, SD 3.0). The most prevalent symptoms among males and females were abdominal pain (57.1%), bloating/distension (32.1%), pelvic pain (18.5%), and abdominal/pelvic mass (18.2%). Overall, patients with early-onset AC [age<50] more commonly presented with symptoms versus cases with late-onset AC (82.9% vs 71.7%, p =0.01). This finding persisted in adjusted models—the number of symptoms was highest among younger patients, rapidly decreased and plateaued around age 50 (IRR 0.97, 95%CI 0.95-0.99, p =0.002), and slowly increased again with older age (IRR 1.03, 95%CI 1.00-1.05, p =0.037). Patient sex was also significantly associated with symptom number, as males had a lower rate of symptoms versus females (IRR 0.63, 95%CI 0.48-0.83, p =0.001). In contrast, histology (IRR 1.03, 95%CI 0.53-2.02), diagnosis year (IRR 1.01, 95%CI 0.99-1.04, p =0.35) and BMI (IRR 1.01, 95%CI 0.99-1.02) were not associated with symptom number in adjusted models. Conclusions: In a large nation-wide cohort, three of every 4 patients were symptomatic prior to primary AC diagnosis. Compared to the rapid time course of acute appendicitis, over 40% of this population presented with symptoms for 3+ months prior to AC diagnosis. The higher symptom burden among young patients and females supports the need for clinical providers to keep occult appendiceal tumors in the differential diagnosis of patients presenting in this manner.

BackgroundLaboratory biomarkers have been used as prognostic markers in several solid tumors. This study aims to evaluate 3 preoperatively measured laboratory values: blood neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), as potential prognostic biomarkers in patients with peritoneal carcinomatosis undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC).MethodsWe performed a retrospective review of 156 patients who underwent CRS-HIPEC between 2013 and 2020. Biomarker ratios were calculated based on the preoperative laboratory values closest to the date of CRS-HIPEC. Multivariable Cox regression models were used to evaluate the biomarkers' associations with survival (OS), recurrence-free survival (RFS), and postoperative outcomes.ResultsIncreased MLR was independently associated with worse OS (P < 0.001) and RFS (P = 0.03) in this patient cohort. Additionally, increased MLR was independently associated with increased rate of hospital re-admission within 30 days after discharge (P = 0.04). None of the analyzed biomarkers were associated with increased rate of Clavien-Dindo class III/IV complication or hospital length of stay.ConclusionsIn this retrospective review, increased preoperative MLR was independently associated with worse overall and recurrence-free survival as well as increased rate of hospital re-admission. Preoperative PLR was associated with increased hospital length of stay. Thus, the utilization of preoperative systemic inflammatory biomarkers may aid in preoperative counseling and risk stratification prior to CRS-HIPEC.

INTRODUCTION:Delayed gastric emptying (DGE) has been related to quality of life and clinical outcomes for gastric cancer patients. The role of lymphadenectomy in postoperative mechanics of gastric emptying remains undefined. This study aims to evaluate the association of D1 versus D2 lymphadenectomy with development of postgastrectomy DGE. MATERIALS AND METHODS:This institutional retrospective study is comprised of clinicopathologic data from patients who underwent gastrectomy between 1994 and 2023. Development of DGE was compared between patients who underwent D1 versus D2 lymphadenectomy in univariate and multivariate analyses, adjusting for other patient-specific and operative characteristics. RESULTS:Of the 302 gastrectomy patients reviewed, 114 underwent distal or subtotal gastrectomy for gastric adenocarcinoma. Thirty of these patients (26.3%) developed DGE. Incidence of DGE was higher among patients who received a D2 (32%) versus D1 lymphadenectomy (15.4%). Adjusted for other covariates, D2 lymphadenectomy was independently associated with an increased likelihood of developing DGE (adjusted odds ratio 3.63, 95% confidence interval 1.12-11.8, P = 0.032). Additional risk factors for DGE identified in multivariate analysis included older age and postoperative complications. While patients with DGE experienced longer postoperative hospitalizations and more frequent 30-d readmissions, there was no difference in 30-d mortality, reoperation, overall survival, or progression-free survival. CONCLUSIONS:In this retrospective study, D2 lymphadenectomy was identified as a risk factor for the development of postgastrectomy DGE in gastric cancer patients. However, long-term outcomes such as survival and cancer progression did not differ based on the development of DGE.

The prognostic impact of genetic mutations for patients who undergo cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) of colorectal origin (CRC) is not well defined. We aimed to describe the genetic classifications in an unsupervised fashion, and the outcomes of this patient population. A retrospective, bi-institutional study was performed on patients who underwent CRS-HIPEC with targeted mutation data with a median follow-up time of 61 months. Functional link analysis was performed using STRING v11.5. Genes with similar functional significance were clustered using unsupervised k-means clustering. Chi-square, Kaplan–Meier, and the log-rank test were used for comparative statistics. Sixty-four patients with peritoneal carcinomatosis from CRC origin underwent CRS-HIPEC between 2007 and 2022 and genetic mutation data were extracted. We identified 19 unique altered genes, with KRAS (56

734 Background: Prospective data assessing prevalence of anxiety and depression in a diverse surgical oncology population are currently lacking. Psychological distress may affect patient outcomes in the postoperative setting. The General Anxiety Disorder (GAD) and Patient Health Questionnaire (PHQ9) surveys are validated instruments to assess severity of anxiety and depression, respectively. We aimed to determine the prevalence of anxiety and depression using validated screening tools, and assess associations between anxiety and depression with clinical outcomes in patients presenting to our surgical oncology clinic. Methods: A prospective, surgeon-blinded study was conducted to assess associations of anxiety and depression with postoperative outcomes in patients with histologically proven malignancy who underwent surgical intervention. Preoperatively, the GAD and PHQ9 surveys were administered to evaluate for anxiety and depression, respectively. Frailty level was also assessed using the validated Risk Analysis Index (RAI-C) survey. Postoperative outcomes included rates of ICU admission, 30- and 90-day readmissions, postoperative complications classified by Clavien-Dindo score, and disposition to home versus rehabilitation facilities. Outcomes were compared between different groups as defined by the severity of anxiety and depression. Results: 191 patients met inclusion criteria. The cohort was stratified into three groups by severity of anxiety and depression. Overall, 59 (31%) patients reported at least moderate anxiety as defined by a GAD score ≥5, with 30 (15.7%) patients reporting severe anxiety (GAD score ≥ 10). Similarly, 62 (32%) patients reported at least mild depression as defined by a PHQ9 score ≥5, with 21 (11%) patients experiencing moderate to severe depression (PHQ9 ≥ 10). No difference was detected in length of stay, ICU admission, 30- and 90-day readmission, and postoperative complications. Preoperative frailty, as defined by RAI-C score >21, was also not associated with anxiety or depression. Marital status of single or widowed was found to be significantly associated with mild depression (p=0.027) and moderate to severe depression (p=0.028), respectively. Conclusions: While anxiety and depression were not found to be significantly associated with postoperative outcomes, they are prevalent in surgical oncology patients, affecting approximately one-third of our patient population. The GAD and PHQ9 surveys are validated instruments that can be administered easily to identify surgical oncology patients with psychological distress. Comprehensive evaluation of psychological well-being, in conjunction with a thorough social evaluation, can identify those patients who may benefit from referral to supportive resources.

BACKGROUND:While cholecystectomy is one of the most common operations performed in the United States, there is a continued debate regarding its prophylactic role in elective surgery. Particularly among patients with peritoneal carcinomatosis who undergo cytoreduction surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), further abdominal operations may pose increasing morbidity due to intraabdominal adhesions and potential recurrence. This bi-institutional retrospective study aims to assess postoperative morbidity associated with prophylactic cholecystectomy at the time of CRS-HIPEC.METHODS:We performed a bi-institutional retrospective analysis of 578 patients who underwent CRS-HIPEC from 2011 to 2021. Postoperative outcomes among patients who underwent prophylactic cholecystectomy at the time of CRS-HIPEC were compared to patients who did not, particularly rate of bile leak, hospital length of stay, rate of Clavien-Dindo classification morbidity grade III or greater, and number of hospital re-admissions within 30 days.RESULTS:Of the 535 patients available for analysis, 206 patients (38.3%) underwent a prophylactic cholecystectomy. Of the 3 bile leaks (1.5%) that occurred among patients who underwent prophylactic cholecystectomy, all 3 occurred in patients who underwent a concomitant liver resection. There were no significant differences in hospital length of stay, postoperative morbidity, and number of hospital re-admissions among patients who underwent prophylactic cholecystectomy compared to those who did not.CONCLUSION:Prophylactic cholecystectomy in patients undergoing CRS-HIPEC is not associated with increased morbidity or increased bile leak risk compared to historical data. While the benefits of prophylactic cholecystectomy are not yet elucidated, it may be considered to avoid potential future morbid operations for biliary disease.

Gastric cancer is the fifth most common cancer diagnosis and fourth leading cause of cancer-related death globally. The incidence of gastric cancer in the USA shows significant racial and ethnic disparities with gastric cancer incidence in Korean Americans being over five times higher than in non-Hispanic whites. Since gastric cancer is not common in the USA, there are no current screening guidelines. In countries with higher incidences of gastric cancer, screening guidelines have been implemented for early detection and intervention and this has been associated with a reduction in mortality. Immigrants from high incidence countries develop gastric cancer at lower rates once outside of their country of origin, but continue to be at higher risk for developing gastric cancer. This risk does seem to decrease with subsequent generations. With increasing availability of endoscopy, initiating gastric cancer screening guidelines for high-risk groups can have the potential to improve survival by diagnosing and treating gastric cancer at an earlier stage. This article aims to provide context to gastric cancer epidemiology globally, review risk factors for developing gastric cancer, highlight racial and ethnic disparities in gastric cancer burden in the USA, examine current guidelines that exist in high incidence countries, and suggest future studies examining the efficacy of additional screening in high-risk populations to reduce gastric cancer mortality and disparate burden on ethnic minorities in the USA.

Background: There is a critical need for contemporary education to address peritoneal surface malignancies (PSM). This study delineates the development of an online PSM curriculum for surgical trainees, in conjunction with a national consortium. Methods: A needs assessment survey was administered to attending surgical oncologists and trainees within the consortium, with a focus on current educational practices and preferences for PSM training. The identified focus areas informed the formulation of specific learning objectives and content. Results: The survey was completed by of 86/171 (48.5%) attending surgical oncologists in the group and 70 surgical trainees (56 residents and 14 fellows) from 31 unique institutions. Attending surgical oncologists emphasized trainee familiarity with general PSM principles and peritoneal metastases from lower gastrointestinal and gastric cancers when compared to gynecologic cancers and uncommon primaries (p < 0.001). Attending expectations increased incrementally with the trainee level in the knowledge and patient care domains. Attendings and trainees identified didactics and textbooks as primary modes of learning, although trainees reported using mobile learning tools more frequently. Disease site-specific educational content aligned with learning objectives was uploaded to a previously piloted online learning management system. Clinical management pathways and rotation guides were integrated to enhance the clinical applicability and consistency. Conclusions: Designing a PSM curriculum tailored to the educational needs of both attendants and trainees is feasible by using established pedagogical methods. This study provides a framework for teaching about complex diseases with limited educational literature.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis work was supported partially by the Teaching Innovation Project Grant awarded by Yale University Center for Teaching and Learning to VVB, FG, DS, and KKT.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesI confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesData from this study may be made available upon reasonable request from qualified medical or scientific professionals, provided that the request aligns with the specified purpose and may involve de-identified individual participant data. Access to the requested data is granted after signing a data-access agreement.

e15595 Background: Ovarian metastases (OM) from colorectal cancer (CRC) are a rare phenomenon. There are limited data detailing outcomes from surgical interventions on OM. However, there is a lack of studies integrating genetic aberrations identified in these patients with clinical characteristics. Methods: We conducted a retrospective review of CRC patients with OM. Demographic variables of interest included age and stage at diagnosis, time from diagnosis to discovery of OM, laterality of OM, primary tumor sidedness, and choice of chemotherapy. Next Generation Sequencing was utilized to collect solid tumor DNA sequencing, in addition to cell-free DNA (cfDNA). Results: A cohort of 12 MSI-S patients was identified between December 2023 and January 2024. Median age of diagnosis was 42.5 y/o. Demographics noted: Primary tumor sidedness included descending colon [58%; 86% of these sigmoid] and ascending colon (42%). AJCC T4 (50%) with OM at presentation (83%); unilateral (58%); 57% in the left ovary. 67% of patients underwent bilateral salpingo-oophorectomy (BSO), 25% unilateral resection, and 8.3% had no resection. 9 patients continue to receive treatment; 3 patients are deceased. Tissue NGS data was available for 75% of patients. The most common mutations were p53 (100%), APC (88%), KRAS (G12A, G12C and G12D; 38%), and PIK3CA (25%). cfDNA data was available for 58% of patients; common mutations were APC (86%), p53 (71%), KRAS [G12C (2); G12D; 43%), PMS2 (29%), BRAF V600E (14%) and BRAF amplification (14%). Conclusions: In our cohort, CRC patients with OM were of early age onset with sigmoid > ascending colon cancer with similar molecular alterations by tissue and cfDNA noting increased KRAS aberrations. Hence, NGS should be completed in all CRC as an opportunity to further characterize potentially actionable mutations in patients with OM, expanding precision oncology availability to this select patient population.

After thoroughly reading the study entitled "The Impact of COVID-19 on Patients Diagnosed with Melanoma, Breast and Colorectal Cancer, 1 Hanuschak D. DePiero D. DeMoraes M. et al. The impact of COVID-19 on patients diagnosed with melanoma, breast, and colorectal cancer. Am J Surg. 2023; https://doi.org/10.1016/j.amjsurg.2023.09.040 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar " we would like to congratulate the authors on a thoughtful article and consideration of a relevant and emerging topic. With over 770 million confirmed cases and 6.9 million deaths, the COVID-19 pandemic marks the most significant global health crisis since the Spanish Flu. 2 WHO COVID-19 Dashboard. World Health Organization, Geneva2020https://covid19.who.int/ Google Scholar It has had unpredictable and unforeseen circumstances in terms of widespread infection, individual and community socio-economic impact, and allocation of health-care resources. Like many other diseases, diagnosis and treatment of cancer has felt the weight of this re-direction of human and economic resources combined with the general public's avoidance of healthcare institutions due to fear and misconception.

OBJECTIVE:To identify factors related to research success for academic surgeons. BACKGROUND:Many recognize mounting barriers to scientific success for academic surgeons, but little is known about factors that predict success for individual surgeons. METHODS:A phase 1 survey was emailed to department chairpersons at highly funded U.S. departments of surgery. Participating chairpersons distributed a phase 2 survey to their faculty surgeons. Training and faculty-stage exposures and demographic data were collected and compared with participant-reported measures of research productivity. Five primary measures of productivity were assessed, including the number of grants applied for, grants funded, papers published, first/senior author papers published, and satisfaction with research. RESULTS:Twenty chairpersons and 464 faculty surgeons completed the survey, and 444 faculty responses were included in the final analysis. Having a research-focused degree was significantly associated with more grants applied for [Doctor of Philosophy, incidence rate ratio (IRR) = 6.93; Masters, IRR = 4.34] and funded (Doctor of Philosophy, IRR = 4.74; Masters, IRR = 4.01) compared with surgeons with only clinical degrees (all P < 0.01). Having a formal research mentor was significantly associated with more grants applied for (IRR = 1.57, P = 0.03) and higher satisfaction in research (IRR = 2.22, P < 0.01). Contractually protected research time was significantly associated with more grants applied for (IRR = 3.73), grants funded (IRR = 2.14), papers published (IRR = 2.12), first/senior authors published (IRR = 1.72), and research satisfaction (odds ratio = 2.15; all P < 0.01). The primary surgeon-identified barrier to research productivity was lack of protection from clinical burden. CONCLUSIONS:Surgeons pursuing research-focused careers should consider the benefits of attaining a research-focused degree, negotiating for contractually protected research time, and obtaining formal research mentorship.

Background: Frailty is associated with increased postoperative complications. Despite evidence-based modalities to assess frailty, surgeons often make subjective assessments of patients' ability to tolerate surgery, and preoperative interventions are not commonplace to improve functional status. Objective assessments of frailty in the Surgical Oncology population may improve patient selection for major resections.