Elderly Frail Patient for Laparoscopic Anterior Resection

You are working in the preadmission clinic. An 86-year-old woman is booked for a laparoscopic ultra-low anterior resection for rectal cancer on your list in three weeks' time. She lives alone at home and can comfortably walk 100 metres on the flat. Medical history: Hypertension Transient ischaemic attack two years ago Ex-smoker – 60 pack-year history Chronic renal impairment Medications: Perindopril 4 mg daily Aspirin 100 mg daily Observations: BP 160/85 mmHg HR 82 bpm, regular SpO2 94% on room air Height 1.70 m Weight 51 kg BMI 17.6 kg/m2 A CT abdomen shows a large low rectal cancer and a single nodule in the liver. The surgeon has asked you to provide an opinion on this patient's perioperative risk.