Comprehensive geriatric assessment in surgical decision-making for elderly patients with gastric cancer

Gastric cancer commonly affects older adults whose physiological reserve varies widely at the same chronological age.This minireview examines how comprehensive geriatric assessment (CGA) can inform decisions for adults aged 65 years or older with potentially resectable gastric cancer.We conducted a structured narrative review of PubMed/MEDLINE literature published from January 2000 to August 31, 2026, supplemented by guideline and reference-list searches.CGA evaluates function, frailty, nutrition and sarcopenia, cognition and mood, comorbidity, medications, and social support.Gastric cancer-specific evidence associates frailty, nutritional risk, and sarcopenia with postoperative complications and survival, but most studies are singlecenter and observational.Evidence from general geriatric oncology, including GAP70+, is indirect for surgical decision-making.CGA may identify modifiable deficits, support perioperative optimization, adapt enhanced recovery after surgery, and inform multimodal treatment discussions.However, it should not determine treatment intensity through fixed fit, vulnerable, or frail categories.The proposed pathway is an author-derived conceptual framework rather than a validated decision rule.Prospective comparative studies are needed to determine whether CGA-guided care improves complications, function, treatment completion, quality of life, and survival.