Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery?

ObjectivesTo identify independent predictors of post-operative complications and early mortality in elderly patients operated for colorectal cancer from a comprehensive geriatric assessment [CGA] and Eastern Cooperative Oncology Group performance status [PS].Patients and MethodsPatients ≥ 70 years electively operated for all stages of colorectal cancer from 2006 to 2008 in three hospitals were consecutively included. CGA addressed the following domains pre-operatively: personal and instrumental activities of daily living [IADL], comorbidity, polypharmacy, nutrition, cognition, and depression. The associations between elements of CGA as well as PS and morbidity and mortality were analyzed using multivariate regression models.ResultsPatients (182) with a median age of 80 years (range, 70–94 years) were included. Severe comorbidity was an independent predictor of severe complications (odds ratio [OR] 5.62; 95% CI 2.18 to 14.50) and early mortality (hazard ratio [HR] 2.78; 95% CI 1.50 to 5.17). IADL-dependency and depression were predictors of any complication (OR 4.02; 95% CI 1.24 to 13.09 and OR 3.68; 95% CI 0.96 to 14.08, respectively) while impaired nutrition predicted early mortality (HR 2.39, 95% CI 1.24 to 4.61). When added to the models, PS independently predicted both morbidity and early mortality, and PS was a more powerful predictor than IADL-dependency, depression, and impaired nutrition.ConclusionsIn elderly patients with colorectal cancer, severe comorbidity, IADL-dependency, depression, and impaired nutrition seem to be the most important CGA-elements predictive of post-operative complications and early mortality. As PS predicts all outcomes, a consistent use of PS in studies of cancer surgery is recommended.