179P - The impact of pre-operative nutritional/rehabilitative assessments and support on postoperative outcomes in very elderly gastric cancer patients

Background

The elderly have numerous risk factors, such as comorbidities, undernutrition, and sarcopenia. Therefore, they require careful treatment indications and management in cancer treatment. Body composition and sarcopenia assessment have been performed in gastric cancer preoperative patients to improve perioperative outcomes since 2018, and we have provided nutritional/rehabilitative assessments and medical support to eligible patients with collaborative practice (CP).

Methods

Of 881 patients with gastrectomy between January 2011 and April 2023, aged 80 years or older were included in this study. We compared the short-term perioperative outcomes of patients with preoperative nutritional/rehabilitative assessments and support with CP (supportive (S) group) and without this assessment (non-supportive (NS) group).

Results

Sixty patients in the S group and 103 in the NS group. There were no differences in age, gender, performance status, Charlson comorbidity index, clinical Stage, or preoperative nutritional assessment, but the S group had a higher body mass index (median; S: 22.2 mg/m2 vs. NS: 21.5 mg/m2, p=0.02) and higher ASA-PS (ASA-PS ≥3, S: 48.4 vs. NS: 24.8%, p=0.002). The S group had fewer total gastrectomies (S: 15.0% vs. NS: 29.1%, p=0.037) and more robotic/laparoscopic approaches (S: 75.0% vs. NS: 30.1%, p<0.001). There was no difference in operative time but less blood loss in the S group (S: 50ml vs. NS: 230ml, p<0.001). Overall complications were lower in the S group (S: 20.0% vs. NS: 36.9%, p=0.021), but there was no difference in Clavien-Dindo ≥3 or higher complications (S: 6.7% vs. NS: 12.6%, p=0.21). In particular, the S group had fewer surgical site infections (S: 6.7% vs. NS: 17.5%, p=0.041) and pneumonia (S: 3.3% vs. NS: 15.5%, p=0.009). Postoperative hospital stay was shorter in the S group (S: 11 days vs. NS: 16 days, p<0.001).

Conclusions

Our results suggest that pre-operative nutritional/rehabilitative assessments and support in elderly gastric cancer patients led to fewer postoperative infectious complications and shorter hospital stays.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Sakai City Medical Center.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.