Comprehensive geriatric assessment in patients with gastric and gastroesophageal adenocarcinoma undergoing gastrectomy.
OBJECTIVE
The purpose of this study was to identify clinical and geriatric assessment variables associated with outcome in patients with gastric adenocarcinoma who have undergone gastrectomy.


METHODS
We reviewed demographic, clinical, and geriatric assessment variables, including recent falls, pain, performance status, American Society of Anesthesiologists score, assistive device use, comorbidity, polypharmacy, and weight change, for patients undergoing gastrectomy between 2005 and 2014. Outcome variables included morbidity, mortality, hospital length of stay, and readmission.


RESULTS
Of 279 patients, 133 (48%) underwent total gastrectomy. The 90-day major morbidity rate was 24% and the mortality rate was 1%. Length of hospital stay ≥ 14 days occurred in 38%, with readmission within 30 days in 13%. On multivariate analysis, gastroesophageal junction involvement, (odds ratio [OR] 2.5, 95% confidence interval [1.1-5.8]), additional organ resection, (OR 3.2, [1.6-6.3]), pain score >0 (OR 3.8, [1.6-8.7]), Eastern Cooperative Oncology Group performance status >0, (OR 2.3, [1.2-4.6]), and polypharmacy (OR 2.4, [1.1-5.2]) were associated with major morbidity. Hospital stay ≥ 14 days was associated with age ≥ 75 years (OR 3.9, [1.7-9.2]), total gastrectomy (OR 3.5, [2.0-6.3]), performance status >0 (OR 1.8, [1.0-3.2]), and preoperative chemotherapy (OR 0.3, [0.2-0.7]).


CONCLUSIONS
Future studies are needed to identify methods to improve performance status, as this may improve postoperative complications and resource utilization.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Deep
D
Pujara
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Paul
P
Mansfield
Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jaffer
J
Ajani
Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Mariela
M
Blum
Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Elena
E
Elimova
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Yi-Ju
YJ
Chiang
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Prajnan
P
Das
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Brian
B
Badgwell
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004943:Esophagogastric Junction; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
adenocarcinoma; frailty; gastrectomy; gastric cancer; geriatric assessment