Differential impact of frailty on surgical and non-surgical site complications in patients with gastric cancer undergoing gastrectomy.

[BACKGROUND] The aim of this study was to determine the differential impact of frailty on surgical site complications (SSCs) and non-surgical site complications (non-SSCs) in gastric cancer (GC) patients undergoing gastrectomy.

[METHODS] In this study, frailty was assessed preoperatively using a frailty index (FI) in 395 patients scheduled for gastrectomy for GC between January 2016 and December 2023. Patients were divided into two groups (high FI vs. low FI) to examine the impact of frailty on SSC and non-SSC.

[RESULTS] Overall complication and non-SSC rates were significantly higher in the high FI group, but the two groups had similar rates of SSC. In multivariate analysis, high FI, high BMI, and male were independent risk factors for non-SSC. The incidence of non-SSC was 0% in patients with no applicable risk factors, 3.6% in patients with one applicable risk factor, 13.0% in patients with two applicable risk factors, and 37.1% in patients with all three risk factors (Cochran-Armitage trend test, p < 0.001). The area under the curve (AUC) of the risk prediction model using these three variables to predict non-SSC was 0.760.

[CONCLUSIONS] High FI was an independent risk factor for non-SSC in patients undergoing gastrectomy for GC. Our developed non-SSC risk model combining FI, BMI, and sex effectively identifies individuals at increased risk for non-SSC in GC patients.