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Impact of Frailty and Sarcopenia on Short- and Long-Term Outcomes in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer

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Abstract

Background

The impact of frailty and sarcopenia in patients with gastric cancer is unclear. This study aimed to comprehensively examine the impact of frailty and sarcopenia on the short- and long-term outcomes in elderly patients undergoing radical gastrectomy for gastric cancer.

Methods

We retrospectively assessed 246 patients aged ≥ 65 years who underwent radical gastrectomy. Frailty and sarcopenia were assessed using the modified frailty index (mFI) and psoas muscle mass index (PMI), respectively.

Results

There were 30 (12.2%) and 60 (24.4%) patients with High-mFI and Low-PMI, respectively. As the age increased, both sexes showed significant correlations with PMI and mFI (r = − 0.238, 0.322, P = 0.003 and 0.002, respectively). High-mFI and Low-PMI did not affect the short-term outcomes. However, High-mFI was an independent risk factor for non-home discharge (P = 0.004) and was a significant predictor of 3- and 5-year overall survival (OS) (HR = 2.76 and 2.26; P = 0.002 and 0.005, respectively) and 1-, 3- and 5-year non-cancer-specific survival (non-CSS) (HR = 4.88, 8.05, and 4.01; P = 0.017, < 0.001, < 0.001, respectively). Low-PMI was a significant predictor of only 5-year OS (HR = 2.03, P = 0.003) and non-CSS (HR = 2.10, P = 0.020).

Conclusions

Frailty is significant predictor of non-home discharge and 1-, 3-, 5-year OS and 3- and 5-year non-CSS. Sarcopenia is a significant predictor of 5-year OS and non-CSS. Preoperative assessment of both frailty and sarcopenia can help surgeons to select adequate treatment strategies for the elderly population.

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Acknowledgements

We would like to thank Prof. Hisashi Noma for his helpful comments on statics and Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Tottori Prefectural Central Hospital, Department of Surgery, Tottori, Japan

    Tomohiro Osaki, Shigeru Tatebe, Junpei Orihara, Ei Uchinaka, Keigo Ashida & Yasuaki Hirooka

  2. Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine Graduate, Tottori, Japan

    Yoshiyuki Fujiwara

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  1. Tomohiro Osaki
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Correspondence to Tomohiro Osaki.

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Written informed consent was not obtained from the patients; however, all patients were previously informed in the form of an opt-out.

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This study was approved by the ethics boards of the Tottori Prefectural Central Hospital (Approval Number: 2020–23).

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Osaki, T., Tatebe, S., Orihara, J. et al. Impact of Frailty and Sarcopenia on Short- and Long-Term Outcomes in Elderly Patients Undergoing Radical Gastrectomy for Gastric Cancer. World J Surg 47, 3250–3261 (2023). https://doi.org/10.1007/s00268-023-07200-4

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