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Preoperative Comprehensive Geriatric Assessment Predicts Postoperative Risk in Older Patients with Esophageal Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Preoperative risk assessment is important in older patients because they often have comorbidities and impaired organ function. We performed preoperative comprehensive geriatric assessment (CGA) for older patients with esophageal cancer.

Patients and Methods

A total of 217 patients over 75 years old who underwent esophagectomy for thoracic esophageal cancer were analyzed. The CGA was performed preoperatively and included the Mini-Mental State Examination (MMSE), Geriatric Depression Score (GDS), vitality index, Barthel index, and instrumental activities of daily living (IADL). We defined the robust group as patients with normal function on every instrument, and the pre-frail and frail groups as those with functional impairment on one instrument or two or more instruments, respectively. We assessed how the CGA correlated with postoperative complications and prognosis.

Results

Of the 217 patients, 86 (39.6%) were in the robust group, 68 (31.3%) in the pre-frail group, and 63 (29.0%) in the frail group. Postoperative pneumonia (P = 0.026) and anastomotic leakage (P = 0.032) were significantly more common in the frail group. The frail group had a significantly longer postoperative hospitalization period (P = 0.016) and significantly lower rate of discharge to home (P = 0.016). Overall survival (OS) was significantly worse in the frail group (5-year overall survival rate, frail group versus others, 37.8% versus 52.0%, P = 0.046), but it was not significant on multivariate analysis.

Conclusions

The preoperative CGA in older patients with esophageal cancer was associated with risk of postoperative complications.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Kotaro Yamashita MD, PhD, Tomoki Makino MD, PhD, Koji Tanaka MD, PhD, Takuro Saito MD, PhD, Kazuyoshi Yamamoto MD, PhD, Tsuyoshi Takahashi MD, PhD, Yukinori Kurokawa MD, PhD, Kiyokazu Nakajima MD, PhD, Hidetoshi Eguchi MD, PhD & Yuichiro Doki MD, PhD

  2. Department of Surgery, Kansai Medical University, Osaka, Japan

    Makoto Yamasaki MD, PhD

  3. Department of Geriatric and General Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan

    Yukiko Yasunobe PT, MSc, Hiroshi Akasaka MD, PhD & Hiromi Rakugi MD, PhD

Authors
  1. Kotaro Yamashita MD, PhD
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  2. Makoto Yamasaki MD, PhD
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  3. Tomoki Makino MD, PhD
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  4. Koji Tanaka MD, PhD
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  5. Takuro Saito MD, PhD
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  6. Kazuyoshi Yamamoto MD, PhD
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  7. Tsuyoshi Takahashi MD, PhD
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  8. Yukinori Kurokawa MD, PhD
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  9. Yukiko Yasunobe PT, MSc
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  10. Hiroshi Akasaka MD, PhD
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  11. Hiromi Rakugi MD, PhD
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  12. Kiyokazu Nakajima MD, PhD
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  13. Hidetoshi Eguchi MD, PhD
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  14. Yuichiro Doki MD, PhD
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Corresponding author

Correspondence to Kotaro Yamashita MD, PhD.

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The authors declare no conflicts of interests.

Ethics approval

This study has a retrospective design and was approved by the Institutional Ethics Review Committee (certificate no. 13350T1-6).

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Yamashita, K., Yamasaki, M., Makino, T. et al. Preoperative Comprehensive Geriatric Assessment Predicts Postoperative Risk in Older Patients with Esophageal Cancer. Ann Surg Oncol 30, 901–909 (2023). https://doi.org/10.1245/s10434-022-12778-5

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  • DOI: https://doi.org/10.1245/s10434-022-12778-5

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