Association between intraoperative cerebral desaturation detected by near-infrared spectroscopy and early postoperative cognitive changes in patients undergoing laparoscopic major oncologic surgery: a

Breast cancer represents a significant and growing global health challenge. With an estimated 2.3 million new cases diagnosed annually, it has become the most commonly diagnosed cancer worldwide, surpassing lung cancer in incidence according to the GLOBOCAN 2022 estimates. Notably, breast cancer ranks as the fifth leading cause of global cancer mortality, accounting for approximately 685,000 deaths each year, thereby posing a substantial threat to women’s health across all regions []. This burden is particularly pronounced in aging populations. In China, as in many other countries undergoing demographic transition, the absolute number of older women diagnosed with breast cancer is projected to increase rapidly in the coming decades [], creating urgent needs for specialized geriatric oncology care. In geriatric oncology, the concept of frailty has gained paramount importance. The World Health Organization (WHO) defines frailty as “a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is compromised” []. This multidimensional syndrome serves as a robust predictor of numerous adverse health outcomes in older populations, including postoperative complications, chemotherapy toxicity, unplanned hospitalizations, functional decline, and increased mortality [–]. Beyond its physical manifestations, frailty encompasses psychological and social dimensions that collectively diminish quality of life and treatment tolerance []. The intersection of breast cancer and frailty in older women presents a complex clinical scenario. Advancing age is a primary risk factor for both conditions [, ]. Moreover, a cancer diagnosis and its associated treatments can accelerate the development or worsening of frailty through mechanisms such as sarcopenia, nutritional deficiencies, chronic inflammation, and toxicity from chemotherapy, radiotherapy, and surgery [–]. Supporting this, Gilmore et al. [] found that breast cancer survivors had a higher prevalence of frailty compared to non-cancer counterparts. Specific treatment modalities, including adjuvant chemotherapy, radiotherapy, and endocrine therapy, have been identified as significant risk factors for functional decline and the onset of frailty in this population [, ].