Purpose: To assess the prevalence of preoperative frailty in patients with oesophageal cancer and its impact on postoperative outcomes and overall survival., Methods: A comprehensive computer-based search of the CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library, Web of Science and CINAHL databases was conducted for articles related to preoperative frailty in patients with oesophageal cancer. The search was carried out from the time of the construction of the database to 20 April 2024. Data related to the prevalence of preoperative frailty in patients with oesophageal cancer and their postoperative outcomes and overall survival were extracted., Results: A total of 13 studies were included, including 12 cohort studies and 1 cross-sectional study involving 53 485 patients. Meta-analysis showed that the prevalence of preoperative frailty in patients with oesophageal cancer was 29.6% (95% CI 24.5% to 34.8%). Preoperative frailty increased the risk of postoperative mortality (HR 1.80, 95% CI 1.51 to 2.14, p<0.001), complications (HR 1.32, 95% CI 1.16 to 1.49, p<0.001) and 30-day readmission (HR 1.24, 95% CI 1.18 to 1.31, p<0.001), in patients with oesophageal cancer, but had no significant effect on overall survival (HR 1.28, 95% CI 0.97 to 1.68, p=0.08)., Conclusions: The prevalence of preoperative frailty is high in patients with oesophageal cancer, and preoperative frailty is strongly associated with increased adverse outcomes after surgery. Healthcare providers should identify preoperative frailty in patients with oesophageal cancer at an early stage and develop targeted intervention strategies to reduce the incidence of postoperative adverse outcomes., Prospero Registration Number: CRD42024541051., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)