Background: This study aimed to clarify the relationship between frailty and postoperative outcomes of laparoscopic gastrectomy for old–old patients with resectable gastric cancer. Methods: The study retrospectively analyzed 96 consecutive patients (age ≥ 80 years) who had undergone R0 resection by laparoscopic gastrectomy for gastric cancer between 2006 and 2012. The patients were retrospectively scored using the clinical frailty scale (CFS) and categorized based on their scores (1–2, 3–4, and 5–7). Postoperative complications, 5-year survival rate, risk factors for morbidity, and prognosis were analyzed. Results: The morbidity rate for Clavien–Dindo grades 2 or higher and 3a or higher were respectively 27.1% and 12.5%. Operative complications, especially systemic complications, were positively associated with an increase in CFS scores (p = 0.026). The overall 5-year survival rate was 59.8%, and the 5-year survival rates for those with a CFS score of 1–2, 3–4, and 5–7 were respectively 70.9%, 59.8%, and 35.1%. Specifically, the prognosis for the patients with a CFS score of 5–7 with stage 2 or 3 disease was significantly worse than for those with a lower CFS score (p = 0.009). The multivariate analysis showed that a total gastrectomy or blood loss of 200 g or more was a significant risk factor for morbidity (both p = 0.004), and that the independent risk factors for overall survival were a CFS score of 5–7 (p = 0.006), a body mass index lower than 18.5 kg/m2 (p = 0.039), and morbidity (grade ≥ 3a; p = 0.002). Conclusions: Frailty has a great impact on operative morbidity and prognosis in the elderly, and the CFS score could be a promising prognostic predictor, especially for frail patients with advanced gastric cancer.
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