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Background: Reported perioperative mortality in gastric cancer surgery is relatively high (4-16%). This may be due increased patient age and poor condition related to advanced tumor stage at time of diagnosis. Comorbidity and age are currently the main factors associated with the risk of surgical mortality however their predictive value is limited. Better preoperative evaluation tools have become warranted for better patient selection and preventing unnecessary surgery related mortality. The aim of the study was to investigate the additional value of frailty and nutritional status assessment for predicting perioperative performance.
Methods: Patients in our hospital are screened for frailty at admission using a scoring questionnaire to assess their GFI (Groningen Frailty Indicator) which entails Activities of Daily Living, self-perceived physical and mental fitness and multipharmacy. Further, nutritional status is assessed using SNAQ (Short Nutritional Assessment Questionnaire). We evaluated in a retrospective analysis whether these scores were associated with 30-day mortality considering standard clinicopathological parameters.
Results: From January 2005 to September 2012 180 patients underwent surgery for gastric cancer with an overall 30-day mortality of 8.3%. Complete GFI and SNAQ scores were available in 127 (71%) and 160 (89%) cases respectively. Univariate analysis showed a cumulative mortality risk in association with increasing GFI score (P<0.001). Patients with a GFI ≥ 3 (n=30, 24%) had a mortality rate of 23.3% versus 5.2% in the lower GFI group (OR 4.0, 95%CI 1.1 to 14.1, P = 0.03). This was independent from patient age, ASA classification, tumor stage and type of surgery. SNAQ score ≥1 (n=98, 61%) was associated with a mortality rate of 13.3% versus 3.2% in the group that scored 0 (OR 5.1, 95% CI 1.1 to 23.8, P=0.04). This was also independent for patients age, type of surgery, tumor stage and ASA classification. Patients who were in the group of both GFI ≥3 and SNAQ ≥1 (n=25, 19%) had a mortality rate of 28% versus 6% in the remaining patients (OR 6.1, 95% CI 1.7 to 22.4, P=0.006). This finding was also independent for patients age, type of surgery, tumor stage and ASA classification.
Discussion: This is the first study that shows a significant relation between gastric cancer surgical mortality and geriatric frailty as well as nutritional status using a simple scoring questionnaire. This information may be of value in the preoperative decision making for selecting patients who would optimally benefit from surgery for gastric cancer.