老年胃癌患者胃切除术后的衰弱状况

Frailty in Elderly Gastric Cancer Patients Undergoing Gastrectomy.

作者信息

Kim Guowei, Min Sa-Hong, Won Yongjoon, Lee Kanghaeng, Youn Sang Il, Tan Bo Chuan, Park Young Suk, Ahn Sang-Hoon, Park Do Joong, Kim Hyung-Ho

机构信息

University Surgical Cluster, National University Health System, Singapore, Singapore.

Department of Surgery, Seoul National University Bundang Hospital, Seoul, Republic of Korea.

出版信息

Dig Surg. 2020 Dec 8:1-7. doi: 10.1159/000511895.

DOI:10.1159/000511895

PMID:33291099

Abstract

INTRODUCTION

There is a dearth of literature on frailty specifically in elderly (aged ≥65 years) gastric cancer patients undergoing gastrectomy. We aim to assess the effects of frailty on postoperative outcomes.

METHODS

A review of a prospective database was performed from November 2011 to April 2019. Frailty was assessed by multidimensional frailty score (MFS). Outcomes assessed were early postoperative complications and mortality, and length of stay.

RESULTS

289 patients were included. The mean age was 77.3 (range 66-94) years. 183 (63.3%) were males and 172 (59.5%) had early cancer. 275 (95.2%) underwent minimally invasive gastrectomy. 79 (27.3%) patients suffered early postoperative complications, with 47 (16.3%) suffering from Clavien-Dindo grade ≥2 complications. One-year, 90-day, 30-day, and inhospital mortality were 6.6, 1.4, 0.7, and 0%, respectively. 111 (38.4%) of patients were classified as "frail" based on MFS > 5. "Frail" patients were associated with higher 1-year mortality (odds ratio (OR) 4.51, 95% CI 1.57-12.98, p = 0.005) on univariate analysis. On multivariate analysis, "frail" patients did not have significantly increased 1-year mortality. However, when definition of "frail" was changed from MFS > 5 to MFS > 6, frailty was significantly associated with increased 1-year mortality (OR 3.73, 95% CI 1.11-12.53, p = 0.033).

CONCLUSIONS

Elderly gastric cancer patients undergoing gastrectomy with MFS > 5 do not have increased mortality risk. The influence of frailty on postoperative outcomes may vary based on the risk of the surgical procedure.

摘要

引言

关于老年（年龄≥65岁）胃癌患者行胃切除术后虚弱状况的文献匮乏。我们旨在评估虚弱对术后结局的影响。

方法

对2011年11月至2019年4月的前瞻性数据库进行回顾。通过多维虚弱评分（MFS）评估虚弱状况。评估的结局包括术后早期并发症、死亡率及住院时间。

结果

纳入289例患者。平均年龄为77.3岁（范围66 - 94岁）。183例（63.3%）为男性，172例（59.5%）患有早期癌症。275例（95.2%）接受了微创胃切除术。79例（27.3%）患者发生术后早期并发症，其中47例（16.3%）发生Clavien - Dindo≥2级并发症。1年、90天、30天及住院期间死亡率分别为6.6%、1.4%、0.7%和0%。根据MFS>5，111例（38.4%）患者被归类为“虚弱”。单因素分析显示，“虚弱”患者1年死亡率较高（优势比（OR）4.51，95%置信区间1.57 - 12.98，p = 0.005）。多因素分析显示，“虚弱”患者1年死亡率无显著增加。然而将“虚弱”的定义从MFS>5改为MFS>6时，虚弱与1年死亡率增加显著相关（OR 3.73，95%置信区间1.11 - 12.53，p = 0.033）。