title: Role of frailty and nutritional status in predicting complications following total gastrectomy with D2 lymphadenectomy in patients with gastric cancer: a prospective study.
abstract: OBJECTIVE
  This study was performed to determine the association of frailty and nutritional status with postoperative complications after total gastrectomy (TG) with D2 lymphadenectomy in patients with gastric cancer.
  
  
  METHODS
  Patients undergoing TG with D2 lymphadenectomy for gastric cancer between August 2014 and February 2016 were enrolled. Frailty was evaluated by sarcopenia which was diagnosed by a combination of third lumbar vertebra muscle index (L3 MI), handgrip strength, and 6-m usual gait speed. Nutritional status was evaluated by the nutritional risk screening 2002 (NRS 2002) score. Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed.
  
  
  RESULTS
  A total of 158 patients were analyzed, and 27.2 % developed complications within 30 days of surgery. One patient died within 30 days of the operation. In the univariate analyses, NRS 2002 score ≥3 (OR = 2.468, P = 0.012), sarcopenia (OR = 2.764, P = 0.008), and tumor located at the cardia (OR = 2.072, P = 0.046) were associated with the postoperative complications. Multivariable analysis revealed that sarcopenia (OR = 3.084, P = 0.005) and tumor located at the cardia (OR = 2.347, P = 0.026) were independent predictors of postoperative complications.
  
  
  CONCLUSIONS
  This study showed a significant relationship between postoperative complications and geriatric frailty using sarcopenia in patients with gastric cancer after TG with D2 lymphadenectomy. Frailty should be integrated into preoperative risk assessment and may have implications in preoperative decisionmaking.
authors.affiliation: Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Fan-Feng
authors.initials: FF
authors.lastname: Chen
authors.affiliation: Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Fei-Yu
authors.initials: FY
authors.lastname: Zhang
authors.affiliation: The First Clinical Medical Institute, Wenzhou Medical University, Wenzhou, China.
authors.forename: Xuan-You
authors.initials: XY
authors.lastname: Zhou
authors.affiliation: Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
authors.forename: Xian
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai, 200072, China. yuzhen0577@gmail.com.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Yu
authors.affiliation: Department of Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China. zhuangchengle@126.com.|Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 301 Yanchang Road, Shanghai, 200072, China. zhuangchengle@126.com.
authors.forename: Cheng-Le
authors.initials: CL
authors.lastname: Zhuang
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D018737:Hand Strength; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D018570:Risk Assessment; D055948:Sarcopenia / Q000150:complications*; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D000072797:Walking Speed
keywords: D2 lymphadenectomy; Frailty; Morbidity; Nutritional status; Sarcopenia; Total gastrectomy