Comparative value of frailty versus ECOG performance in preoperative risk assessment for elderly patients with gastric cancer.

[BACKGROUND] Radical gastrectomy with D2 lymphadenectomy reduces the postoperative recurrence in gastric cancer, but increases risk of complications, especially among elderly patients. This study aimed to assess the predictive value of frailty in determining postoperative complication risks in patients aged ≥80 years undergoing D2 gastrectomy.

[METHODS] This prospective observational study enrolled 78 patients aged ≥80 years who underwent gastrectomy with D2 lymphadenectomy for gastric cancer between January 2020 and December 2021 ​at a medical center in Taiwan. Frailty was evaluated using the Comprehensive Geriatric Assessment (CGA) within one week before surgery.

[OUTCOMES] Length of hospital stay (LOS), intensive care unit (ICU) stays, postoperative complications, and survival were analyzed and compared with the Eastern Cooperative Oncology Group (ECOG) performance status.

[RESULTS] Among the 78 patients, ECOG performance scores were 0, 1, 2, and 3 in 47 ​%, 40 ​%, 12 ​%, and 1 ​% of patients, respectively; 19 patients (24 ​%) were classified as fit and 59 (76 ​%) as frail based on CGA. Frail patients had a significantly longer median LOS (20 days vs. 12 days, p ​= ​0.001), a higher ICU admission rate (46 ​% vs. 16 ​%, p ​= ​0.027), a higher incidence of any surgical complication (85 ​% vs. 47 ​%, p ​= ​0.001), and an increased rate of major surgical complications (Accordion grade 2 or higher) (24 ​% vs. 0 ​%, p ​= ​0.012) compared to fit patients. Although ECOG performance was associated with major complication rates, it did not significantly predict LOS, ICU admissions, or overall complication rates. Survival did not differ significantly between the frail and ECOG performance groups.

[CONCLUSIONS] This study demonstrates that frailty is commonly observed in Taiwanese octogenarian patients and is a valuable predictor of postgastrectomy outcomes.