Frailty in Elderly Gastric Cancer Patients Undergoing Gastrectomy

Abstract

<b><i>Introduction:</i></b> There is a dearth of literature on frailty specifically in elderly (aged ≥65 years) gastric cancer patients undergoing gastrectomy. We aim to assess the effects of frailty on postoperative outcomes. <b><i>Methods:</i></b> A review of a prospective database was performed from November 2011 to April 2019. Frailty was assessed by multidimensional frailty score (MFS). Outcomes assessed were early postoperative complications and mortality, and length of stay. <b><i>Results:</i></b> 289 patients were included. The mean age was 77.3 (range 66–94) years. 183 (63.3%) were males and 172 (59.5%) had early cancer. 275 (95.2%) underwent minimally invasive gastrectomy. 79 (27.3%) patients suffered early postoperative complications, with 47 (16.3%) suffering from Clavien-Dindo grade ≥2 complications. One-year, 90-day, 30-day, and inhospital mortality were 6.6, 1.4, 0.7, and 0%, respectively. 111 (38.4%) of patients were classified as “frail” based on MFS &#x3e; 5. “Frail” patients were associated with higher 1-year mortality (odds ratio (OR) 4.51, 95% CI 1.57–12.98, <i>p</i> = 0.005) on univariate analysis. On multivariate analysis, “frail” patients did not have significantly increased 1-year mortality. However, when definition of “frail” was changed from MFS &#x3e; 5 to MFS &#x3e; 6, frailty was significantly associated with increased 1-year mortality (OR 3.73, 95% CI 1.11–12.53, <i>p</i> = 0.033). <b><i>Conclusions:</i></b> Elderly gastric cancer patients undergoing gastrectomy with MFS &#x3e; 5 do not have increased mortality risk. The influence of frailty on postoperative outcomes may vary based on the risk of the surgical procedure.