High preoperative modified frailty index has a negative impact on short- and long-term outcomes of octogenarians with gastric cancer after laparoscopic gastrectomy
The proportion of elderly patients who undergo surgery has rapidly increased. However, clinical indicators that predict outcomes are limited. Frailty is thought to estimate physiological reserves, although its use has not been evaluated in laparoscopic surgical patients. This study aimed to evaluate the significance of preoperative modified frailty index (PMFI) in octogenarians undergoing a laparoscopic gastrectomy.
We reviewed prospectively collected data from 119 patients with gastric cancer (GC) aged 80 years or older who underwent a radical laparoscopic gastrectomy (RLG) between January 2007 and December 2012. Three baseline frailty traits were measured using routine preoperative laboratory data: albumin < 3.4 g/dL, haematocrit < 35%, and creatinine > 2 mg/dL. Patients were categorized by the number of positive traits as follows: low preoperative modified frailty index (LPMFI): 0–2 traits and high preoperative modified frailty index (HPMFI): 3 traits. We compared patient characteristics, operative outcomes, pathological results, morbidity, and survival.
A total of 43 (36.1%) patients were considered HPMFI, and 76 (63.9%) patients were considered LPMFI. HPMFI was associated with an increased risk of postoperative complications (HPMFI group: odds ratio 2.506; 95% CI, 1.113–5.643, P = 0.027). With a median follow-up of 39.0 months, the 3-year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates for the entire cohort were 47.9, 34.3, and 51.7%, respectively. Significant differences were observed in OS (HPMFI group, 37.2%; LPMFI group, 53.9%; P = 0.038) and RFS (HPMFI group, 23.3%; LPMFI group, 40.5%; P = 0.012) between the groups, but no difference was found for CSS (HPMFI group, 43.5%; LPMFI group, 56.4%; P = 0.078).
HPMFI based on an easily calculable preoperative measure may be useful for predicting postoperative complications and have a negative impact on 3-year OS and RFS after an RLG in octogenarians. Therefore, HPMFI can serve as a low-cost, simple screen for high-risk individuals who might suffer more than expected during the postoperative period after an RLG.
KeywordsFrailty Octogenarians Laparoscopic gastrectomy Short- and long-term outcomes
The authors are thankful to Fujian Medical University Union Hospital for their management of our gastric cancer patient database. All the authors are grateful for the statistics related consultation provided by the Public Health School of Fujian Medical University.
Compliance with ethical standards
Jun Lu, Chao-Hui Zheng, and Chang-Ming Huang designed the study; Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-long Cao, Mi Lin, and Ru-Hong Tu collected the data. All the authors participated in interpreting the data, drafting the article, critically revising the paper for content, and providing final approval of the version submitted for publication. All the authors have seen, approved, and are completely familiar with the contents of the manuscript. All the authors are responsible for the accuracy of the manuscript, including the statistical calculations. Jun Lu, Chao-Hui Zheng, Chang-Ming Huang, Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-bin Wang, Jian-Xian Lin, Qi-Yue, Chen, Long-long Cao, Mi Lin, and Ru-Hong Tu have no conflicts of interest or financial ties to disclose.
- 4.Fujiwara Y, Tsujie M, Hara J, Kato H, Kitani K, Isono S, Takeyama H, Yukawa M, Inoue M, Kanaizumi H (2014) Comparison of gastric cancer surgery between patients aged> 80 years and < 79 years: complications and multivariate analysis of prognostic factors. Hepato-Gastroenterol 61:1785–1793Google Scholar
- 9.Ness KK, Krull KR, Jones KE, Mulrooney DA, Armstrong GT, Green DM, Chemaitilly W, Smith WA, Wilson CL, Sklar CA, Shelton K, Srivastava DK, Ali S, Robison LL, Hudson MM (2013) Physiologic frailty as a sign of accelerated aging among adult survivors of childhood cancer: a report from the St Jude lifetime cohort study. J Clin Oncol 31:4496–4503CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Sobin LH, Gospodarowicz MK, Wittekind C (2010) International Union Against Cancer (UICC) TNM classification of Malignanttumours, 7th edn. Wiley, New YorkGoogle Scholar
- 34.Obeid NM, Azuh O, Reddy S, Webb S, Reickert C, Velanovich V, Horst HM, Rubinfeld I (2012) Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: exploring frailty and aggressive laparoscopic approaches. J Trauma Acute Care Surg 72:878–883CrossRefPubMedGoogle Scholar
- 35.Green P, Arnold SV, Cohen DJ, Kirtane AJ, Kodali SK, Brown DL, Rihal CS, Xu K, Lei Y, Hawkey MC, Kim RJ, Alu MC, Leon MB, Mack MJ (2015) Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial). Am J Cardiol 116:264–269CrossRefPubMedPubMedCentralGoogle Scholar