Impact of frailty on outcomes in older patients after curative gastrectomy for cancer: a matched-pair analysis

Background Frailty influences surgical results beyond chronological age alone. We assessed the impact of preoperative frailty on early mortality and other outcomes in elderly patients undergoing curative gastric cancer surgery.Materials and methods Prospective cohort study and matched-pair analysis of gastric cancer patients aged 70 years or older undergoing elective curative gastrectomy between March 2019 and March 2022. Frailty was assessed within 2 weeks preoperatively using the modified Frailty Index (mFI-11) with a threshold mFI-11 of 0.27. Matched-pair analysis assessed the strength of the association between frailty and outcomes after adjusting for confounding variables, including age, sex, body mass index, serum albumin, cT stage, neoadjuvant therapy, surgical approach, type of gastrectomy, and surgical radicality.Results The study identified 432 patients (63.9% males, mean age 78.6 years), 92 of which showed an mF-11 score ≥ 0.27, with a prevalence of frailty of 21%. Frail patients showed a higher risk of 90-day mortality (RR, 12.0; 95% CI, 1.59-90.40), higher rate of complications (RR, 1.55; 95% CI, 1.11-2.15), major complications (RR, 2.27; 95% CI, 1.19-4.34), failure to rescue (RR, 6.24; 95% CI, 1.91-42.85), and failure to rescue-surgical (RR, 6.29; 95% CI, 1.87-45.33). Frailty was also associated with higher 30-day and 1-year mortality, but differences in conditional survival were not found. Frail patients showed meaningful improvements in health-related quality of life at 1 year.Conclusion Frailty is a significant risk factor of early postoperative mortality and morbidity in elderly gastric cancer patients, highlighting a critical window for targeted interventions in this cohort.Clinicaltrials Gov id NCT03568110.