Gastric cancer is the fifth most common cancer in the world with more than 26 500 new diagnoses and 11 130 deaths annually in the United States.¹ Although the incidence has declined, some studies suggest that there is increasing incidence and mortality in younger patients,² and 5-year survival rate is still poor at 30%.³ Surgical resection is potentially curative; however, variation in extent of lymph node dissection and type of perioperative chemotherapy and radiation therapy have led to numerous paradigms for therapeutic sequencing in advanced resectable gastric cancer.

Frailty is a common phenomenon in older adult population and associated with an elevated risk of adverse health outcomes. Recent studies have demonstrated that patients with frailty undergoing surgery had a significantly higher morbidity and mortality compared to those without frailty. This is particularly important in patients with cancer because the prevalence of frailty is persistently high across a spectrum of primary cancers. Identifying frailty in oncological patients undergoing surgery may provide an important preoperative intervention opportunity to mitigate operative risks. In this review, we provide an overview of frailty and its association with other geriatric syndromes. We will also review the impact of frailty on postoperative outcomes focusing on the field of surgical oncology. We then describe currently available tools to objectively measure frailty to provide clinicians with various practical tools that may be adopted in their clinical practice. Finally, we will describe potential interventional programs, including the recently introduced Geriatric Surgery Verification program by the American College of Surgeons, that may be institutionally adopted to mitigate postoperative complications and improve meeting patient-centered goals in the frail patient population.

BACKGROUND: Patients older than 65 years have unique needs and treatment outcome goals. The objective of this study was to evaluate the impact of Geriatric Surgery Verification (GSV) initiative in oncology patients 65 years or older undergoing major abdominal operation. STUDY DESIGN: We implemented the American College of Surgeons GSV program protocols for patients 65 years and older starting in 2022. A retrospective review was conducted of patients undergoing major abdominal oncologic operation from January 2021 through December 2022 to create pre-GSV and post-GSV initiative cohorts. Main outcome variables were postoperative institutionalization and change in the patient’s primary residence disposition (measured as Primary Residence Score as a proxy for loss of independence). RESULTS: A total of 57 patients in the control group and 43 patients in the intervention group met inclusion criteria. The average age was 76.5 and 75 years, respectively. Patients were well matched for clinical and sociodemographic characteristics. The intervention group had a shorter mean length of stay (4.4 ± 2.5 days vs 6.5 ± 3.6 days in the control group [p < 0.01]) and were less likely to be newly discharged to an institution (7.3% vs 24.1%, p = 0.03). The GSV initiative was associated with 72% lower odds of increased Primary Residence Score (ie care needs) at time of discharge (odds ratio 0.28, 95% CI 0.1 to 0.81). CONCLUSIONS: The GSV initiative intervention in geriatric oncology patients undergoing major abdominal operation was associated with reducing postoperative institutionalization and change in primary residence disposition. Further studies to explore different mechanisms within GSV that lead to improved outcomes in geriatric oncologic population will be informative.