Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy. Sarcopenia Adversely Impacts Postoperative Clinical Outcomes Following Gastrectomy in Patients with Gastric Cancer: A Prospective Study Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study Impact of Visceral Obesity and Sarcopenia on Short-Term Outcomes After Colorectal Cancer Surgery Sarcopenia in overweight and obese patients is a predictive factor for postoperative complication in gastric cancer: A prospective study. Prognostic Significance of Sarcopenia in Patients with Esophagogastric Junction Cancer or Upper Gastric Cancer Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer Impact of preoperative hand grip strength on morbidity following gastric cancer surgery Sarcopenic Obesity Is Associated with Severe Postoperative Complications in Gastric Cancer Patients Undergoing Gastrectomy: a Prospective Study Minimally invasive surgery for colorectal cancer: quality of life and satisfaction with care in elderly patients Value of sarcopenia assessed by computed tomography for the prediction of postoperative morbidity following oncological colorectal resection: A comparison with the malnutrition screening tool. Sarcopenia: Prevalence, and Impact on Operative and Oncologic Outcomes in the Multimodal Management of Locally Advanced Esophageal Cancer Activities of Daily Living and Quality of Life of Elderly Patients After Elective Surgery for Gastric and Colorectal Cancers Influence of nutritional treatment on the postoperative course in patients with gastric cancer. How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center
BACKGROUND A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer . However , the current geriatric assessment has been considered to be either time-consuming or subjective . The present study aim ed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy . MATERIAL S AND METHODS We conducted a prospect i ve study of patients who underwent radical gastrectomy from August 2014 to December 2015 .  Computed tomography-assessed lumbar skeletal muscle , h and grip strength , and gait speed were measured to define sarcopenia . RESULTS Sarcopenia was present in 69 of 240 patients ( 28.8 % ) and was associated with lower body mass index , lower serum albumin , lower hemoglobin , and higher nutritional risk screening 2002 scores . Postoperative complications significantly increased in the sarcopenic patients ( 49.3 % versus 24.6 % , P < 0.001 ) , compared with nonsarcopenic patients . The multivariate analysis demonstrated that sarcopenia ( odds ratio : 2.959 , 95 % CI : 1.629 - 5.373 , P < 0.001 ) and the Charlson comorbidity index ≥2 ( odds ratio : 3.357 , 95 % CI : 1.144 - 9.848 , P = 0.027 ) were independent risk factors for postoperative complications . CONCLUSIONS Sarcopenia , presented as a new geriatric assessment factor , was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer Background Sarcopenia is characterized by decreased skeletal muscle plus low muscle strength and /or physical performance . This study was performed to determine the association of sarcopenia with short-term postoperative outcomes after gastrectomy for gastric cancer . Methods We conducted a prospect i ve study of 255 consecutive patients with gastric cancer who underwent curative gastrectomy .  The sarcopenia elements , including lumbar skeletal muscle index , h and grip strength , and gait speed , were measured before surgery . Patients were followed up after gastrectomy to gain the actual clinical outcomes . Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis . Results Sarcopenia was present in 32 of 255 patients ( 12.5 % ) , and was significantly correlated with advance age , lower body mass index , higher nutritional risk screening ( NRS ) 2002 score , and lower preoperative serum albumin and hemoglobin . Compared with non-sarcopenic patients , sarcopenic patients had a higher risk of postoperative complications , longer postoperative hospital stay , and more hospital costs . In univariate analysis , sarcopenia ( p < 0.001 ) , nutritional risk ( NRS 2002 score ≥3 ; p = 0.003 ) , advanced age ( ≥75 years ; p = 0.014 ) , anemia ( p = 0.012 ) , hypoalbuminemia ( p = 0.029 ) , and diabetes ( p = 0.014 ) were associated with postoperative complications . Multivariable analysis revealed that sarcopenia ( p < 0.001 ) and diabetes ( p = 0.006 ) were independent predictors of postoperative complications . Conclusions Sarcopenia is an independent predictor of postoperative complications in patients with gastric cancer after gastrectomy OBJECTIVE To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery . BACKGROUND Functional compromise in elderly colorectal surgical patients is considered as a significant factor of impaired postoperative recovery . Therefore , the predictive value of preoperative functional compromise assessment was investigated . Sarcopenia is a hallmark of functional compromise . METHODS A total of 310 consecutive patients who underwent oncologic colorectal surgery  were included in a prospect i ve digital data base . Sarcopenia was assessed using the L3 muscle index utilizing Osirix on preoperative computed tomography . Groningen Frailty Indicator and Short Nutritional Assessment Question naire scores were used to assess frailty and nutritional compromise . Predictors for anastomotic leakage , sepsis , and mortality were analyzed by logistic regression analysis . RESULTS Age was an independent predictor of mortality [ P = 0.04 ; odds ratio , 1.17 ; 95 % confidence interval ( CI ) , 1.01 - 1.37 ] . Thirty-day/in-hospital mortality rate in sarcopenic patients was 8.8 % versus 0.7 % in nonsarcopenic patients ( P = 0.001 ; odds ratio , 15.5 ; 95 % CI , 2.00 - 120 ) . Sarcopenia was not predictive for anastomotic leakage or sepsis . Combination of high  Short Nutritional Assessment Question naire score , high Groningen Frailty Indicator score , and sarcopenia strongly predicted sepsis ( P = 0.001 ; odds ratio , 25.1 ; 95 % CI , 5.11 - 123 ) , sensitivity , 46 % ; specificity , 97 % ; positive likelihood ratio , 13 ( 95 % CI , 4.4 - 38 ) ; negative likelihood ratio , 0.57 ( 95 % CI , 0.33 - 0.97 ) . CONCLUSIONS Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome . Assessment of functional compromise by means of a nutritional question naire ( Short Nutritional Assessment Question naire ) , a frailty question naire ( Groningen Frailty Indicator ) , and sarcopenia measurement ( L3 muscle index ) can accurately predict postoperative sepsis Background . The association between sarcopenia and postoperative outcomes has been well reported . However , the impact of different sarcopenia stages on postoperative outcomes has never been investigated . Methods . We conducted a large , prospect i ve study of patients who underwent radical gastrectomy for gastric cancer from August 2014 to December 2015 .  Sarcopenia was staged as “ presarcopenia , ” “ sarcopenia , ” and “ severe sarcopenia ” according to the definition of the European Working Group on Sarcopenia in Older People . Univariate and multivariate analyses evaluating the risk factors for total , surgical , and medical complications were performed . Results . A total of 470 patients were included , in which 20.6 % , 10 % , and 6.8 % of the patients were identified as having “ presarcopenia , ” “ sarcopenia , ” and “ severe sarcopenia  , ” respectively . Postoperative complications , duration of hospital stays , and costs increased with advancing sarcopenia stages . Severe sarcopenia , visceral fat area to total abdominal muscle area ratio , American Society of Anesthesiologists grade III , and tumor located at the cardia were independent risk factors for total complications . Visceral fat area to total abdominal muscle area ratio and tumor located at the cardia were independent risk factors for operative complications . Presarcopenia , sarcopenia , and severe sarcopenia were all identified as independent risk factors for medical complications , as well as age ≥75 years and Charlson Comorbidity Index . Conclusion . Patients had worse  postoperative outcomes after gastric cancer operation with advancing sarcopenia stages . Severe sarcopenia , but not presarcopenia or sarcopenia , was an independent risk factor for total postoperative complications . The 3 sarcopenia stages independently influence medical but not surgical complications . Recognizing sarcopenia stages is important for preoperative risk stratification Purpose One-year mortality is vital for elderly oncologic patients undergoing surgery . Recent studies have demonstrated that sarcopenia can predict outcomes after major abdominal surgeries , but the association of sarcopenia and 1-year mortality has never been investigated in a prospect i ve study . Methods We conducted a prospect i ve study of elderly patients ( ≥65 years ) who underwent curative gastrectomy for gastric cancer from July 2014 to July 2015 . Sarcopenia was determined by the measurements of muscle mass , h and grip strength , and gait speed . Univariate and multivariate analyses were used to identify the risk factors associated with 1-year mortality . Results A total of 173 patients were included , in which 52 ( 30.1 % ) patients were identified as having sarcopenia . Twenty-four ( 13.9 % ) patients died within 1 year of surgery . Multivariate analysis showed that sarcopenia was an independent risk factor for 1-year mortality . Area under the receiver operating characteristic curve demonstrated an increased predictive power for 1-year mortality with the inclusion of sarcopenia , from 0.835 to 0.868 . Solely low muscle mass was not predictive of 1-year mortality in the multivariate analysis . Conclusions Sarcopenia is predictive of 1-year mortality in elderly patients undergoing gastric cancer surgery . The measurement of muscle function is important for sarcopenia as a preoperative assessment tool Background With the increased prevalence of obesity and sarcopenia , those patients with both visceral obesity and sarcopenia were at higher risk of adverse outcomes . Aim The aim of this study was to ascertain the combined impact of visceral obesity and sarcopenia on short-term outcomes in patients undergoing colorectal cancer surgery . Methods We conducted a prospect i ve study from July 2014 to February 2017 . Patients ’ demographic , clinical characteristics , physical performance , and postoperative short-term outcomes were collected . Patients were classified into four groups according to the presence of sarcopenia or visceral obesity . Clinical variables were compared . Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed . Results A total of 376 patients were included ; 50.8 and 24.5 % of the patients were identified as having “ visceral obesity ” and “ sarcopenia , ” respectively . Patients with sarcopenia and visceral obesity had the highest incidence of total , surgical , and medical complications . Patients with sarcopenia or/ and visceral obesity all had longer hospital stays and higher hospitalization costs . Age ≥ 65 years , visceral obesity , and sarcopenia were independent risk factors for total complications . Rectal cancer and visceral obesity were independent risk factors for surgical complications . Age ≥ 65 years and sarcopenia were independent risk factors for medical complications .  Laparoscopy-assisted operation was a protective factor for total and medical complications . Conclusion Patients with both visceral obesity and sarcopenia had a higher complication rate after colorectal cancer surgery . Age ≥ 65 years , visceral obesity , and sarcopenia were independent risk factors for total complications . Laparoscopy-assisted operation was a protective factor BACKGROUND Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength . This study aims to explore the prevalence of sarcopenia in overweight and obese gastric cancer ( GC ) patients and figured out the impacts of sarcopenia on the postoperative complication of overweight and obese GC patients . METHODS According to the recommended body-mass index ( BMI ) for Asian population s by WHO , we conducted a prospect i ve study of overweight and obese gastric cancer patients ( BMI ≥ 23 kg/m2 ) under curative gastrectomy from August 2014 to December 2015 . Including  lumbar skeletal muscle index , h and grip strength and gait speed as the sarcopenic components were measured before surgery . Patients were followed up after gastrectomy to gain the actual clinical outcomes . Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis . RESULTS Total of 206 overweight or obese patients were enrolled in this study , 14 patients were diagnosed sarcopenia and were demonstrated having significantly association with higher risk of postoperative complications , higher hospital costs , and higher rate of 30-days readmission compared with the non-sarcopenic ones . On the basis of univariate and multivariate analysis , sarcopenia was an independent risk factor for postoperative complication of overweight and obese patients with gastric cancer ( P = 0.002 ) . CONCLUSION Sarcopenia is an independent predictor of postoperative complications in overweight or obese patients with gastric cancer after radical gastrectomy Background The association between sarcopenia and postoperative outcomes for patients with gastrointestinal malignancies remains controversial . This study aim ed to assess the impact of sarcopenia on short- and long-term outcomes after surgery for esophagogastric junction cancer ( EGJC ) or upper gastric cancer ( UGC ) . Methods The study review ed 148 patients with EGJC or UGC who underwent surgical resection .  The patients were categorized into the sarcopenia group or the non-sarcopenia group according to their skeletal muscle index calculated using abdominal computed tomography images . The study compared clinicopathologic factors , postoperative complications , and prognosis between the two groups . Results Sarcopenia was present in 19 patients ( 32.2 % ) with EGJC and 23 patients ( 25.8 % ) with UGC . The 5-year overall survival ( OS ) and recurrence-free survival ( RFS ) rates were significantly poorer in the sarcopenia group than in the non-sarcopenia group ( OS 85.5 vs 54.8 % , P = 0.0010 ; RFS 78.7 vs 51.7 % , P = 0.0054 ) . The development of postoperative complications did not differ significantly between the two groups . Both the uni- and multivariate analyses showed that N stage ( P < 0.0001 ) and sarcopenia ( P = 0.0024 and 0.0293 , respectively ) were independent poor prognostic factors for OS . Conclusions Sarcopenia was strongly associated with a poor long-term prognosis for patients with EGJC or UGC who underwent surgery . The results suggest that special attention might be needed during the development of treatment strategies for patients with sarcopenia who intend to undergo operations for EGJC and UGC Abstract Currently , the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated . Moreover , the association between sarcopenia and postoperative complications remains controversial . This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer . From December 2008 to April 2013 , the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospect ively . Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis . Skeletal muscle mass was determined by abdominal ( computed tomography ) CT scan , and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification . Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed . A total of 937 patients were included in this study , and 389 ( 41.5 % ) patients were sarcopenic based on the diagnostic cut-off values ( 34.9 cm2/m2 for women and 40.8 cm2/m2 for men ) . Sarcopenia was an independent risk factor for severe postoperative complications ( OR = 3.010 , P < 0.001 ) , but not for total complications . However , sarcopenia did not show significant association with operative mortality . Moreover , sarcopenia was an independent predictor for poorer overall survival ( HR = 1.653 , P < 0.001 ) and disease-free survival ( HR = 1.620 , P < 0.001 ) . Under the adjusted tumor-node-metastasis ( TNM ) stage , sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III , but not in patients with TNM stage I.Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer . Moreover , sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III , but not in patients with TNM stage Background Sarcopenia is a decrease in both muscle mass and strength . It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery . This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery . Methods A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined . Patients with performance status 3 or 4 were excluded .  Preoperative lean body mass ( LBM ) was evaluated by bioelectrical impedance analysis and expressed as LBM index .  Preoperative muscle function was measured by h and grip strength ( HGS ) . The cutoff values were the gender-specific lowest 20 % . Grade 2 or higher morbidities , as retrospectively evaluated by the Clavien – Dindo classification , were obtained from the patient record . The risk factors for morbidity were examined by univariate and multivariate analyses . Results Morbidity was observed in 39 patients ( 13.3 % ) , including 7 with pancreatic leakage , 12 with anastomotic leakage , and 4 with intraabdominal abscesses , but no mortality was observed . The univariate analysis showed that male gender , total gastrectomy , splenectomy , and a low HGS were significant risk factors for morbidity . A low LBM was not a significant risk factor . A low HGS , male gender , and total gastrectomy remained significant in the multivariate analysis . Conclusions A low h and grip strength was a significant risk factor for morbidity after gastric cancer surgery . The importance of the h and grip strength as a risk factor should be examined in future prospect i ve studies Objective This study aim ed to determine the risk of severe postoperative complications ( SPCs ) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients . Methods We conducted a prospect i ve study of 636 consecutive patients with gastric cancer who underwent radical gastrectomy . Degrees of sarcopenia and obesity were calculated before surgery . Factors contributing to SPCs were determined using univariate and multivariate analysis . A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs . Results Logistic analysis revealed that sarcopenic obesity , age , open surgery , and combined resection were independent prognostic factors for SPCs . Sarcopenic obese patients have the highest risk in all patients ( sarcopenic obesity vs normal , OR = 6.575 p = 0.001 ; sarcopenic obesity vs obesity , OR = 5.833 p = 0.001 ; sarcopenic obesity vs sarcopenia , OR = 2.571 p = 0.032 ) , while obese patients share the similar rate of SPCs with normal people ( obesity vs normal , OR = 1.056 p = 0.723 ) . The nomogram we constructed was able to quantify the risk of SPCs reliably ( c-index , 0.737 ) . Conclusions Sarcopenic obesity , together with age , open surgery , and combined resection are independent predictors of SPCs . Obesity will significantly increase the risk of SPCs in sarcopenic patient with gastric cancer , but it will not bring higher risk to normal patients . Our nomogram is a simple and practical instrument to identify patients at high risk of surgical complications Background The purpose of this multicentric prospect i ve study was to evaluate postoperative HRQL and satisfaction with care after laparoscopic colonic resection for colorectal cancer in elderly patients . Methods A total of 116 patients were enrolled in this study : 33 patients older than age 70 years had laparoscopic colectomy , whereas 24 had open colectomy ; 44 patients younger than age 70 years had laparoscopic colectomy and 15 of them had open colectomy .  The patients answered to three question naires about generic ( EORTC QLQ C30 ) and  disease-specific quality of life  ( EORTC CR29 ) and about  treatment satisfaction  ( EORTC IN-PATSAT32 ) . Nonparametric tests and forward stepwise multiple regression analysis were used for statistical analysis . Results One month after surgery , global quality of life ( QL2 item ) was significantly impaired in elderly patients who had laparoscopic colectomy  compared with younger patients who had the same operation ( p = 0.003 ) . Similarly , role function ( RF ) , physical function ( PF ) , emotional function ( EF ) , cognitive function ( CF ) , and social function ( SF ) were impaired in elderly patients who had laparoscopic colectomy compared with younger patients ( p < 0.001 , p < 0.001 , p = 0.013 , p < 0.001 , p = 0.01 , respectively ) . Fatigue ( FA ) , sleep disturbances ( SL ) , appetite loss ( AP ) , and dyspnea ( DY ) affected the quality of life of these patients more than younger patients ( p < 0.001 , p = 0.055 , p = 0.051 , and p = 0.003 , respectively ) . Conclusions Elderly patients undergoing laparoscopic colectomy for cancer experience less postoperative local complications than elderly patients undergoing open colectomy . Nevertheless , in the first postoperative month , these patients experience a worse global quality of life than younger patients undergoing the same operation with impairment of all the functions and the presence of fatigue , sleep disturbances , appetite loss , and dyspnea BACKGROUND Computed tomography ( CT ) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia . The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool ( MUST ) for the prediction of post-operative morbidity after oncological colorectal resection , whilst correcting for known risk factors . METHODS A prospect i ve cohort study of 80 patients undergoing elective colorectal surgery in the Netherl and s. Patients were screened for nutritional risk upon admission using the MUST . Additionally , preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation . Univariate and multivariable analyses were performed to evaluate associations between the MUST , muscle attenuation and sarcopenia on the one h and and post-operative complications measured by the Clavien-Dindo score on the other h and . RESULTS American Society of Anesthesiology-classification ( ASA ) ≥3 , age ≥70 , MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications ( Clavien-Dindo score ≥2 ) ( p ≤ 0.05 ) , whereas sarcopenia was not ( p = 0.59 ) . Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age ( p = 0.03 , OR 5.8 , 95%CI 1.1 - 29.6 ) , but not when corrected for age ≥70 and ASA ≥3 . Muscle attenuation and sarcopenia were not significantly associated with postoperative complications . CONCLUSION Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery . It also underlines the importance of currently implemented easy-to-use nutritional screening tools ( MUST ) and raises the question of the evaluation of muscle quality versus quantity in body composition imaging . However , further research is needed to investigate the role of sarcopenia for predicting outcome after colorectal surgery , and investigate the role of muscle attenuation measurements for the prediction of muscle function . CATEGORY OF SU BMI SSION : observational study Objective : The aim of this article was to study the prevalence and significance of sarcopenia in the multimodal management of locally advanced esophageal cancer ( LAEC ) , and to assess its independent impact on operative and oncologic outcomes . Summary of Background Data : Sarcopenia in cancer may confer negative outcomes , but its prevalence and impact on modern multimodal regimens for LAEC have not been systematic ally studied . Methods : Two hundred fifty-two consecutive patients were studied .  Lean body mass ( LBM ) , skeletal muscle index ( SMI ) , and fat mass ( FM ) were determined pre-treatment , preoperatively , and 1 year postoperatively . Sarcopenia was defined by computed tomography ( CT ) at L3 as SMI < 52.4 cm2/m2 for males and SMI < 38.5 cm2/m2 for females . All complications were recorded prospect ively , including comprehensive complications index ( CCI ) , Clavien-Dindo complication ( CDC ) , and pulmonary complications ( PPCs ) . Multivariable linear , logistic , and Cox regression analysis was performed . Results : In-hospital mortality was 1 % , and CCI was 21 ± 19 . Sarcopenia increased ( P = 0.02 ) from 16 % at diagnosis to 31 % post-neoadjuvant therapy , with loss of LBM ( -3.0 ± 5.4 kg , P < 0.0001 ) , but not FM ( -0.3 ± 2.7 kg , P= 0.31 ) during treatment . On multivariable analysis , preoperative sarcopenia was associated with CCI ( P = 0.043 ) , and CDC ≥IIIb ( P = 0.003 ) . PPCs occurred in 36 % nonsarcopenic versus 55 % sarcopenic patients ( P = 0.01 ) . Sarcopenia did not impact disease-specific ( P = 0.14 ) or overall survival ( P = 0.11 ) after resection . At 1 year , 35 % had sarcopenia , significantly associated with pre-treatment BMI ( P = 0.013 ) but not complications ( P = 0.20 ) . Conclusions : Sarcopenia increases through multimodal therapy , is associated with an increased risk of major postoperative complications , and is prevalent in survivorship . These data highlight a potentially modifiable marker of risk that should be assessed and targeted in modern multimodal care pathways Objective : To establish reliable st and ards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living ( ADL ) and quality of life ( QOL ) . Summary Background Data : ADL and QOL are important outcomes of surgery for the elderly . However , there has been only limited evidence on the natural course of recovery of functional independence . Methods : Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospect ively examined .  Physical conditions , ADL , and QOL  were evaluated preoperatively and at the first , third , and sixth postoperative month . Results : The mortality and morbidity rates were 0.4 % and 28 % , respectively . Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively , but most patients recovered from this transient reduction , with only 3 % showing a decline at the sixth postoperative month ( 6POM ) . ADL of these patients was likely to decrease after discharge from the hospital . QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores . Conclusions : Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer , only a few showed a protracted decline in ADL and most exhibited better QOL after surgery . This indicates that surgical treatment should be considered , whenever needed , for elderly patients 75 years old or older with gastric or colorectal cancer . Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability ; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients PURPOSE Malnutrition occurs in ca . 60 % of all patients with gastric cancer . The obligatory st and ard for a curative radical oncological procedure is gastrectomy inclusive of regional lymph nodes . Nutritional treatment is expected to decrease possibilities of postoperative complications in patients subjected to curative surgery .  The study is aim ed at comparing treatment results in patients with gastric cancer subjected to radical surgery , nutritional and non-nutritional treatment respectively  . MATERIAL AND METHODS The study included 176 patients qualified for curative surgery of a total or subtotal gastrectomy . Analysed were 2 groups of patients : group I -- not subjected to nutritional treatment , group II -- subjected to nutritional treatment , both in the circumoperative period . The groups were compared in respect to : 1 ) age , 2 ) sex , 3 ) nutritional condition , 4 ) degree of clinical cancer development , 5 ) histopathological cancer type , 6 ) kind of surgical procedure performed , 7 ) antibiotic and antithrombotic prevention . All complications observed in the patients were divided into four kinds : surgical of a high or low risk and general of a high or low risk . RESULTS Given the above-mentioned estimation parameters , no statistically significant differences between both groups were recorded . Of 176 patients , 27 % showed surgical complications and 40 % had general complications . No difference ( p = 0.60 ) in the incidence of a high and low risk surgical complications between groups I and II in the circumoperative period was observed , a significant difference ( p = 0.03 ) was recorded in the incidence of general complications . Low risk general complications ( respiratory infections ) were shown to occur significantly more often ( p = 0.005 ) in patients receiving either parenteral or enteral nutrition after surgery . CONCLUSIONS A significant part of the patients with a medium degree and a medium to heavy degree of malnutrition subjected to a curative gastrectomy can pass through the postoperative period without using either parenteral or enteral nutrition and with no violations of all the other principles of the postoperative procedure as well as without provoking any significant increase of surgical complications . In case surgical complications should occur and delay resuming natural feeding , it is necessary that parenteral and /or enteral nutritional treatment be undertaken according to clinical circumstances and condition of the patient concerned ; such proceedings increase chances of cure Objective Cancer is one of the most common diagnoses in elderly patients . Of all types of abdominal cancer , colorectal cancer ( CRC ) is undoubtedly the most frequent . Median age at diagnosis is approximately 70 years old worldwide . Due to the multiple comorbidities affecting elderly people , frailty evaluation is very important in order to avoid over- or under-treatment . This pilot study was design ed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC . Methods Patients with 70 years old and older undergoing elective surgery for CRC were prospect ively enrolled in the study . The patients were preoperatively screened using 11 internationally-vali date d-frailty- assessment tests . The endpoints of the study were long-term mortality and living situation . The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors . Results Forty-six patients were studied . The median follow-up time after surgery was 4.6 years ( range , 2.9 - 5.7 years ) and no patients were lost to follow-up . The overall mortality rate was 39 % . Four of the patients who survived ( 4/28 , 14 % ) lost their functional autonomy . The preoperative impaired Timed Up and Go ( TUG ) , Eastern Cooperative Group Performance Status ( ECOG PS ) , Instrumental Activities of Daily Living ( IADLs ) , Vulnerable Elders Survey ( VES-13 ) scoring systems were significantly associated with increased long term mortality risk . Conclusion Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk . The TUG , ECOG-PS , IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability . Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients
ConclusionS arcopenia and frailty seem to have significant adverse impacts on the occurrence of postoperative outcomes .
Background Gastric cancer is a major health problem , and frailty and sarcopenia will affect the postoperative outcomes in older people .
However , there is still no systematic review to determine the role of frailty and sarcopenia in predicting postoperative outcomes among older patients with gastric cancer who undergo gastrectomy surgery .