Our study aimed to develop and validate the Maladaptive Eating Behavior Questionnaire after Metabolic and Bariatric Surgery (MEBQMBS). Based on the conceptual framework of maladaptive eating behavior after metabolic and bariatric surgery (MBS), literature review, focus group discussion, and a pilot study, the initial questionnaire was developed. The questionnaire was administered to 457 patients who had undergone MBS at a tertiary hospital in Jiangsu Province, China. Its validity and reliability were evaluated using psychometric analyses. The initial questionnaire comprised 90 items. After stepwise removal of items with inadequate factor loadings, 53 items were retained, accounting for 69.54

Introduction: It was challenging to accurately measure the maladaptive eating behavior after bariatric surgery. Our study was aimed to develop and validate the Maladaptive Eating Behavior Questionnaire after Bariatric Surgery (MEBQBS). Methods: The initial questionnaire was developed through concept clarification, literature review, focus group discussion, and pilot study. Its reliability and validity were also examined in 457 patients after bariatric surgery. Results: The final 53-item MEBQBS comprised 8 factors, including emotional eating (negative emotion, positive emotion sub-domain), grazing behavior, food craving (positive outcome expectancy, emotional craving, preoccupation with food sub-domain), uncontrolled eating (cognition, behavior sub-domain). Exploratory factor analysis revealed a cumulative variance contribution rate of 69.54%. Confirmatory factor analysis revealed that the indices of c 2 /df, goodness-of fit index, normed fit index, incremental fit index, Tucker-Lewis index, confirmatory fit index and root mean-square error of approximation were 1.868, 0.804, 0.884, 0.943, 0.934, 0.942, and 0.050, indicating the model fit well. Additionally, significant correlations were observed between the total score of MEBQBS and the Three-Factor Eating Questionnaire-R21 ( P <0.05). The Cronbach's α and Guttman split-half coefficient of MEBQBS were 0.966 and 0.790, respectively. Conclusion: The MEBQBS is a valid and reliable instrument for identifying unhealthy eating behavior of patients after bariatric surgery, offering potential utility in evaluating the effect of tailored interventions.

BACKGROUND:Bariatric surgery, particularly laparoscopic procedures, is becoming increasingly common for achieving sustained weight loss. However, the decision-making process is complex and influenced by psychological, social, and medical factors. Despite its growing relevance, there is a lack of research exploring patients' perceptions and expectations regarding bariatric surgery in China. This study aims to explore patients' perceptions, concerns, expectations, and hopes related to the outcomes of bariatric surgery. Additionally, it investigates patients' information received, education, and support needs both pre- and post-surgery. METHODS:The study included 68 individuals aged above 18 years who had undergone bariatric surgery. Participants were recruited from four hospitals in China, and data were collected through a self-administered open-ended questionnaire. The data were analyzed using a thematic analysis approach. RESULTS:The study uncovered that a majority of individuals had experienced unsuccessful dieting attempts before opting for bariatric surgery. Concerns and fears about bariatric surgery included potential complications and long-term effects. Expected benefits ranged from weight loss to improved health indicators, enhanced lifestyle, and psychological well-being. Participants voiced varied information needs, emphasizing trust in medical professionals, and a desire for detailed information on surgical procedures, risks, and postoperative care. Participants varied in pre-operative expectations, highlighting the need for detailed surgery explanations, psychological counseling, and assurance of suitability. For post-operative, they sought responsive communication and emphasized continuous follow-up to achieve sustainable weight loss. CONCLUSION:Findings underscore the necessity for healthcare professionals to address diverse patient expectations, dispel myths, and provide ongoing support to ensure successful outcomes and long-term weight management post-bariatric surgery.

Background:Diet and physical activity (PA) are pivotal behaviors for managing energy balance post-bariatric surgery. Given the need for dual behavioral management, understanding the interplay of cognitive factors influencing these behaviors is crucial. This study applied the compensatory carry-over action model (CCAM) to explore the impact of cognitive factors on behaviors and their subsequent effects on subjective health outcomes.Methods:This cross-sectional study was conducted among patients at the third month after bariatric surgery in China. Data on diet and PA status, behavioral cognitive factors (intention, self-efficacy, compensatory belief, transfer cognition), and subjective health outcomes (perceived stress, well-being, quality of life) were collected. Structural equation model (SEM) was employed to test hypotheses in CCAM and assess mediation relationships.Results:Analysis of data from 239 patients revealed the following: (1) Among antecedent cognitive factors, only compensatory belief significantly influenced diet (P<0.001). (2) Intention and self-efficacy directly correlated with their respective behaviors, while compensatory belief affected intention, and transfer cognition impacted self-efficacy (P<0.05), aligning with CCAM hypotheses. (3) PA demonstrated significant influence only on perceived stress (P=0.004), whereas diet significantly affected all subjective health outcomes (P<0.05). (4) Mediation analysis indicated intention partially mediated the relationship between compensatory belief and diet and fully mediated the relationship between compensatory belief and PA. Self-efficacy completely mediated the relationship between transfer cognition and diet and PA.Conclusion:Transfer cognition's carry-over effect did not directly influence behaviors among antecedent cognitions. Interventions should primarily target improving diet by mitigating compensatory belief. Moreover, diet exhibited a more pronounced impact on overall health compared to PA. Consequently, prioritizing dietary intervention over PA intervention is warranted based on the analysis of CCAM and the aim of promoting joint behaviors post-bariatric surgery.

Background: Performing bariatric surgery on patients with a BMI of over 50 kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. Materials and methods: A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted. Results: Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44 702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50 kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly. Conclusion: Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50 kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.

Background Maladaptive eating behavior after bariatric surgery is an im-portant cause of postoperative weight regain. However, the depth and reliability of its related research has been greatly hindered partially by non-unification of its concept and inappro-priate words used to explain the concept. Objective To clarify the concept of maladaptive eating behavior after bariatric surgery. Methods In May 2022, database of CNKI, WanFang Data, SinoMed, PubMed, Web of Science and CINAHL were systematically searched for studies in Chinese or English mainly about maladaptive eating behavior after bariatric surgery from inception to May 10, 2022, involving related concepts, definition attributes, antecedents and consequences. The contents of included literature were analyzed using the Rodgers' process of concept analysis, involving the evolution, attributes, antecedents, consequences, related concepts, typical case, assumptions and enlightenment for further development. Results Altogether, 36 studies were included, 33 of which in English, and the other three were in Chinese. The conceptual attributes of maladaptive eating behavior after bariatric surgery were composed of six aspects: uncontrolled eating, grazing, emotional eating, food craving, food addiction and compensatory behaviors. The antecedents include subjective factors (containing self-efficacy, dietary attitude, psychological status, work pressure and so on) , and objective factors (containing age, gender, education level, obesity history and others) . Eating disorders, mental illness, weight-loss outcome, nutritional status and quality of life compose the consequences. Conclusion The concept of maladaptive eating behavior after bariatric surgery is still non-unified. Its meanings in China should be discussed according to the national condition, and in-depth research on relevant theories, assessment tools, influencing factors and intervention should be conducted on this foundation, so as to maintain the effect of bariatric surgery and improve the quality of life in these patients.

Objective:To construct and apply the informatized weight management mode for patients undergoing bariatric and metabolism sugery based on ecological momentary assessment.Methods:Using the convenient sampling method, a total of 150 patients who underwent bariatric and metabolism surgery in the First Affiliated Hospital of Nanjing Medical University from July 2019 to October 2020 were selected as the research objects. According to the random number table method, they were randomly divided into the intervention group and the control group, with 75 cases in each group. The weight-loss outcomes, eating behavior, exercise behavior and complication rate were compared between the two groups.Results:There were significant differences in body mass index (t=2.439, P=0.016), excess weight loss percentage (t=1.991, P=0.048), body fat mass percentage (t=2.777, P=0.006), anemia cases (χ2=4.641, P=0.036), and vitamin D deficiency cases (χ2=4.891, P=0.031) between the two groups (P<0.05).Conclusions:Our study found the informatized weight management mode for patients undergoing bariatric and metabolism sugerybased on ecological momentary assessment can improve weight-loss outcomes andeatingbehavior, also reduce the incidence of anemia and vitamin D deficiency.

目的 探讨基于云康复平台的全周期管理对减重患者手术效果的影响.方法 采用便利抽样法,选取2020年2月-2021年9月在南京医科大学第一附属医院行减重手术的125例患者为研究对象,采用随机数字表法,根据纳排及脱落标准分为对照组(61例)和观察组(64例).对照组予以常规健康宣教、治疗和随访;观察组患者在此基础上,应用云康复平台在手术全周期实施管理,干预时间为预约手术起至术后6个月.采用生物电阻抗法在基线和术后测量患者的身体成分指标,包括体重、BMI、体脂率和骨骼肌含量,收集手术相关指标包括:住院时间、住院费用、术后并发症和术前合并症缓解情况,以综合评估手术效果.结果 术后6个月时,观察组患者的体重、BMI、体脂率和骨骼肌含量相较于对照组均显著下降,差异有统计学意义(P＜0.05),住院时间和住院费用显著降低(P＜0.05),观察组合并症缓解情况均显著优于对照组(P＜0.05).结论 云康复平台的全周期管理能显著改善减重代谢手术患者的临床结局.

目的 比较6种不同阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)筛查工具在减重代谢术前病人OSA筛查中的准确性.方法 便利取样法选取2022年6月至2023年7月南京医科大学第一附属医院减重代谢外科收治的拟行减重代谢手术病人357例,分别应用STOP-Bang量表、Epworth嗜睡量表、Berlin量表、No-Apnea量表、四变量评分、GOAL评分进行评估,并以便携式睡眠监测仪作为参照标准,通过DeLong测试比较各工具的受试者工作特征曲线下面积(area under curve,AUC)、灵敏度、特异度和预测值,计算正确诊断指数(Youden指数)以确定各筛查工具的最佳截断值.结果 基于便携式睡眠监测诊断结果,减重术前病人OSA发生率为61.6％(220/357),使用6种筛查工具得出存在OSA风险的发生率为40.7％～91.0％.筛查轻中重度OSA时(呼吸暂停低通气指数≥5次/h),Berlin量表和STOP-Bang量表的受试者工作特征AUC相对更高(0.82、0.79),灵敏度较高(69.90％、67.96％),特异度也较好(82.81％、76.56％),对应的最佳截断值均为4分.结论 6种OSA筛查工具均具有一定的临床实用性和准确性,Berlin量表和Stop-Bang量表准确性、灵敏度、特异度相对较高.

ObjectiveTo develop a dietary compliance scale for patients after bariatric and metabolic surgery 3 months or more and to test its reliability and validity.MethodsA pre⁃test scale was formed through literature review，Delphi expert consultation，and pre⁃investigation.A total of 323 patients after bariatric and metabolic surgery in a tertiary grade A hospital in Jiangsu province were investigated on their subsequent visit using the pre-test scale to test the reliability and validity of the scale.ResultsA 16⁃item diet compliance scale for patients after bariatric and metabolic surgery was finally formed.Exploratory factor analysis showed that four factors （diet control，nutrient intake，fluid intake，and eating habits）were extracted，and the cumulative variance contribution rate reached 53.90%.Confirmatory factor analysis results showed that the model fits well.The content validity of each scale item was 0.800⁃1.000，the scale's content validity was 0.875，the Cronbach's alpha coefficient was 0.834，the split⁃half reliability was 0.741，and the test⁃retest reliability was 0.827.ConclusionsThe developed scale of dietary compliance for patients after bariatric and metabolic surgery had good reliability and validity，which could provide an effective tool for the assessment of dietary compliance of patients after bariatric and metabolic surgery 3 months or more.

Objectives: The aim of this study was to compare the performance of five sarcopenia screening tools in preoperative patients with gastric cancer, including strength, assistance with walking, rise from a chair, climb stairs, and falls; strength, assistance with walking, rise from a chair, climb stairs, falls, and calf circumference (SARC-CalF); Ishii score chart; short version of the mini sarcopenia risk assessment; and full version of the mini sarcopenia risk assessment.Methods: We conducted a cross-sectional study of consecutive patients undergoing a gastrectomy between May 2020 and October 2020. Sarcopenia was diagnosed per the diagnostic criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Data on the five sarcopenia screening tools, patient characteristics, nutrition risk screening 2002, and diagnostic indicators of sarcopenia were collected preoperatively, and pathological characteristics of the tumor were collected postoperatively. Based on the EWGSOP2 criteria, the clinical validity of the sarcopenia tools was measured using sensitivity, specificity, and predictive value. A receiver operator characteristic curve and area under curve were applied to compare the overall screening accuracy, and a Youden index was calculated to determine the optimal cutoff value of each tool.Results: We included 260 participants age 62.38 11.21 y. Based on the EWGSOP2 criteria, the prevalence of sarcopenia and severe sarcopenia were 8.46% and 4.62%, respectively. Moreover, the prevalence of sarcopenia risk ranged from 3.46% to 73.85% based on the five screening tools. Of these tools, SARC-CalF had the largest area under the curve (0.896) with moderate-to-high sensitivity (86.36%) and high specificity (92.86%). For SARC-CalF, the cutoff value of 10 reached the highest Youden index, and the corresponding sensitivity and specificity were 81.82% and 93.44%, respectively. Conclusion: Among the above five screening tools, SARC-CalF appeared to be the optimal choice to screen sarcopenia in preoperative patients with gastric cancer.(c) 2021 Elsevier Inc. All rights reserved.

A 67-year-old male patient took 250 mg gefitinib daily because of epidermal growth factor receptor (EGFR) gene 21 exon mutation in lung cancer. Three months later, the patient developed cough, shortness of breath, and high fever. The chest computerized tomography (CT) suggested pneumonia, and anti-infection treatment was ineffective. After that, gefitinib was discontinued, and oxygen inhalation, intravenous drip of glucocorticoids, liver protection and other treatments were given. His symptoms were significantly relieved one week later.

目的 探讨袖状胃切除术后病人1年体质量指数(BMI)变化的类别,识别其发展轨迹,并探索不良BMI轨迹的预测因素.方法 2017年6月～2020年6月我院接受袖状胃切除手术治疗的肥胖病人241例,利用基线以及术后1、3、6、12个月的BMI数据构建增长混合模型.按照潜在类别分组对其基线资料进行组间比较.结果 共得到3种不同类型的BMI变化轨迹,分别命名为常规减重(29.5％)、快速减重(27.0％)和缓慢减重(43.6％).组间年龄、性别、婚姻状况比较差异有统计学意义.配对比较发现,性别和婚姻状况在组间的差异具有高效应.结论 43.6％病人在袖状胃切除术后BMI下降趋势缓慢,女性和已婚是病人术后1年BMI下降趋势不理想的重要预测因素,病人年龄较轻也可辅助预测其术后减重效果.

Objective:To explore the effect of preoperative energy-restricted well-balanced diet intervention on postoperative nausea and vomiting and related prognostic indicators in patients with sleeve gastrectomy.Methods:Using the convenient sampling method, a total of 408 patients who underwent sleeve gastrectomy in the First Affiliated Hospital of Nanjing Medical University from July 2020 to July 2021 were selected as the research objects. According to the random number table method, they were randomly divided into the intervention group and the control group, with 204 cases in each group. The control group was given routine preoperative dietary care, while the intervention group was given preoperative energy-restricted well-balanced diet intervention. The incidence of postoperative nausea and vomiting, early postoperative drinking water compliance rate and preoperative hyperglycemia were compared between the two groups.Results:The incidence of PONV and the incidence of preoperative hyperglycemia in the intervention group were lower than those in the control group, and the postoperative drinking water compliance rate was higher than that in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Preoperative energy-restricted well-balanced diet intervention can reduce the incidence of postoperative nausea and vomiting in patients with sleeve gastrectomy, increase the postoperative drinking water compliance rate and reduce the incidence of preoperative hyperglycemia.

To explore main determinants of dietary adherence among Chinese patients after bariatric surgery based on the Attitude-Social influence-Efficacy (ASE) model. A cross-sectional survey was conducted by using convenience sampling method to select 288 participants in a tertiary hospital in Jiangsu, China. General information and disease-related information were collected as well as applying the Dietary Adherence Scale after Bariatric Surgery (DASBS) and Attitude-Social influence-Efficacy Questionnaire after Bariatric Surgery (ASEQBS). Univariate analysis, correlation analysis, and multivariate analysis were used to identify determinants of dietary adherence among patients after bariatric surgery. A total of 288 questionnaires were effectively collected. The mean DASBS score was 54.90 ± 10.08 among post-bariatric patients. Univariate analysis results showed that education level, time since surgery, smoking, exercise, participation in peer support groups, and participation in nutrition counseling had significant effects on postoperative diet adherence level of patients (P < 0.05). The correlation analysis results showed that the total score of dietary adherence was positively correlated with the total score of intention, attitude, social influence, and self-efficacy, and the correlation coefficients were 0.511, 0.550, 0.460, and 0.484, respectively (P < 0.05). The results of multiple linear regression analysis showed that time since surgery, attitude, intention, social influence, exercise, and self-efficacy entered the regression equation (P < 0.05). The standardized regression coefficients of attitude and intention are 0.237 and 0.196, respectively. The regression model could explain 44.0% of the total variation. The dietary adherence of Chinese post-bariatric patients is at an upper-middle level, which needs to be further improved. Time since surgery, exercise, intention, attitude, social influence, and self-efficacy had significant effects on patients’ dietary adherence. Attitude had the greatest effect on dietary adherence, followed by intention. The results shed light on that these factors should be emphasized to take personalized intervention strategy in designing dietary intervention program, in order to improve the patient’s dietary adherence and surgical outcomes.

目的:编制适用于术后3个月及以上的减重代谢手术病人的饮食依从性量表,并检验其信度及效度.方法:通过文献回顾、德尔菲专家咨询、预调查形成预试量表,对江苏省某三级甲等医院复诊的323例减重代谢术后病人进行调查,检测量表的信效度.结果:最终形成16个条目的减重代谢术后病人饮食依从性量表,探索性因子分析提取饮食控制、营养素摄入、液体摄入、进食习惯4个因子,累计方差贡献率达53.90％;验证性因子分析结果显示模型拟合良好.量表各条目的内容效度为0.800～1.000,量表内容效度为0.875,量表Cronbach'sα系数为0.834,折半信度为0.741,重测信度为0.827.结论:编制的减重代谢术后病人饮食依从性量表具有良好的信效度,可为术后3个月及以上的减重代谢术后病人饮食依从性评估提供有效工具.

目的 探讨持续膀胱冲洗的最佳冲洗速度.方法 选择2020年2-5月79例行经尿道前列腺电切术后患者为对照组,2020年6-8月81例行经尿道前列腺电切术后患者为实验组.对照组采用传统膀胱冲洗方法,实验组按照本研究确定的最佳冲洗速度冲洗.比较2组患者尿管堵塞、膀胱痉挛发生情况及冲洗时间,分析培训前后护士对膀胱冲洗引流液的认知情况.结果 培训后,20名护士对膀胱冲洗引流液的颜色描述、出血量估算、护理记录填写、冲洗速度调节的正确率高于培训前,差异有统计学意义(P＜0.05).实验组尿管堵塞、膀胱痉挛发生率低于对照组,冲洗时间短于对照组,差异有统计学意义(P＜0.05).结论 本研究自制的膀胱冲洗引流液比色卡及通过临床试验确定的特定颜色应匹配的最佳冲洗速度,显著改善了持续膀胱冲洗的效果,降低了尿路堵塞、膀胱痉挛的发生率,缩短了冲洗时间,有利于患者恢复并减轻了护士工作负担.

目的 比较5种不同肌肉减少症筛查工具在胃癌患者术前营养评定中的应用效果.方法 便利选取2020年5月—10月江苏省某三级甲等医院收治的拟行胃癌手术的患者270例,分别应用肌肉减少症五条目问卷、改良版肌肉减少症五条目(Strength,Assis tance with walking,Rise from a Chair,Climb Stairs,Falls and Calf Circumference,SARC-CalF)问卷、Ishii评分、迷你肌肉减少症风险评估-7条目问卷和迷你肌肉减少症风险评估-5条目问卷对其进行评估,并基于2019年亚洲肌肉减少症工作组(Asian Working Group for Sarcopenia,AWGS 2019)提出的诊断标准,采用SPSS 20.0和MedCalc 19.0.4软件计算灵敏度、特异度和预测值,绘制受试者操作特征曲线,计算曲线下面积,并通过计算Youden指数,确定各筛查工具的最佳截断值.结果 依据AWGS 2019提出的诊断标准,胃癌患者术前肌肉减少症的发生率为8.76％,使用5种评估工具得出存在肌肉减少症风险的发生率为3.42％～73.76％.上述5种筛查工具在胃癌患者术前肌肉减少症筛查中的灵敏度为26.09％～95.65％,特异度为28.33％～98.75％,受试者操作特征曲线下面积为0.696～0.901.其中,SARC-CalF问卷的受试者操作特征曲线下面积相对更高(0.901),且其灵敏度(82.61％)和特异度(92.08％)也较好,此时对应的最佳截断值为10分.结论 5种肌肉减少症筛查工具均具有一定的临床实用性和准确性,使用SARC-CalF问卷对胃癌患者术前进行肌肉减少症筛查更具灵敏度、特异度和准确性.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:分析近20年超重和肥胖人群心理卫生相关研究,比较国内外该人群心理卫生相关研究热点。方法:检索万方、知网、PubMed数据库2000年1月-2020年4月收录的超重和肥胖人群心理相关研究,采用BICOMB、gCLUTO软件对关键词和主题词进行聚类和可视化分析。研究人群为中国人的研究定义为国内研究,其余均视为国外研究。结果:最终纳入国内研究661篇、国外研究3679篇。聚类分析显示,国内关注肥胖型多囊卵巢综合征、儿童青少年、肥胖合并症患者等;国外侧重于减重术后及暴食症患者、儿童青少年等。结论:国内外研究热点仅在儿童、青少年方面较为相似。国内在存在肥胖合并症的临床疾病领域发展较好,而国外所关注的减重术后患者生活质量及心理状况、正念疗法和认知行为疗法的运用等值得国内研究者借鉴。</span>

Background: Frailty is common in patients who undergo digestive system tumor surgery. This review aimed to explore the effects of preoperative frailty on multiple outcomes following surgery among patients with digestive system tumors. Methods: PubMed (Medline), Embase, Web of Science, and other databases were searched from the inception of each database to April 2021. Meta-analysis or qualitative synthesis was performed to examine the relationship between preoperative frailty and adverse postoperative outcomes. Results: A total of 29 studies encompassing 122,548 patients were included. Through meta-analysis, frailty was associated with an increased risk of total complications (risk ratio [RR] 1.44; 95 % confidence interval [CI] 1.39 to 1.50), major complications (RR 1.72; 95 % CI 1.51 to 1.95), 30-d mortality (RR 2.40; 95 % CI 2.14 to 2.70), and 5-year mortality (RR 1.74; 95 % CI 1.35 to 2.24). Through qualitative synthesis, compared with non-frail patients, two studies found that frail patients had a worse quality of life, and three studies reported that frail patients experienced greater rates of non-home discharge. However, two studies demonstrated inconsistent conclusions regarding the relationship between frailty and functional status. Conclusions: Preoperative frailty was an important risk factor for multiple adverse postoperative outcomes of patients with digestive system tumors, including objective clinical outcomes and patient-centered outcomes. Future studies focusing on the effects of frailty on patient-centered outcomes such as quality of life and functional status are needed. (C) 2021 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.