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High preoperative modified frailty index has a negative impact on short- and long-term outcomes of octogenarians with gastric cancer after laparoscopic gastrectomy

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgements

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.

Funding

National key clinical specialty discipline construction program of China (No. [2012]649). Scientific and technological innovation joint capital projects of Fujian Province, China (No.2016Y9031). Minimally invasive medical centre of Fujian Province (2011708#). The youth research project of Fujian Provincial Health and Family Planning Commission (2014-1-48). QIHANG funds of Fujian Medical University (No. 2016QH025). Fujian nature and health joint fund project (2015J01464).

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    Authors and Affiliations

    1. Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China

      Jun Lu, Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-long Cao, Mi Lin, Ru-Hong Tu, Chang-Ming Huang & Chao-Hui Zheng

    2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

      Jun Lu, Hua-Long Zheng, Ping Li, Jian-Wei Xie, Jia-bin Wang, Jian-Xian Lin, Qi-Yue Chen, Long-long Cao, Mi Lin, Ru-Hong Tu, Chang-Ming Huang & Chao-Hui Zheng

    3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China

      Jun Lu, Ping Li, Jian-Wei Xie, Jia-bin Wang, Jian-Xian Lin, Chang-Ming Huang & Chao-Hui Zheng

    4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China

      Jun Lu, Ping Li, Jian-Wei Xie, Jia-bin Wang, Jian-Xian Lin, Chang-Ming Huang & Chao-Hui Zheng

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    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.

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    Jun Lu and Hua-Long Zheng contributed equally to this work and should be considered co-first authors.

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    Lu, J., Zheng, HL., Li, P. et al. High preoperative modified frailty index has a negative impact on short- and long-term outcomes of octogenarians with gastric cancer after laparoscopic gastrectomy. Surg Endosc 32, 2193–2200 (2018). https://doi.org/10.1007/s00464-018-6085-4

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