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Use of a Comprehensive Geriatric Assessment to Predict Short-Term Postoperative Outcome in Elderly Patients With Colorectal Cancer

대한대장항문학회지 2016년 32권 5호 p.161 ~ 169
 ( Lee Yoon-Hyun ) - Seoul National University Bundang Hospital Department of Surgery

 ( Oh Heung-Kwon ) - Seoul National University Bundang Hospital Department of Surgery
 ( Kim Duck-Woo ) - Seoul National University Bundang Hospital Department of Surgery
 ( Ihn Myong-Hoon ) - Soonchunhyang University Gumi Hospital Department of Surgery
 ( Kim Jee-Hyun ) - Seoul National University Bundang Hospital Department of Internal Medicine
 ( Son Il-Tae ) - Seoul National University Bundang Hospital Department of Surgery
 ( Kang Sung-Il ) - Seoul National University Bundang Hospital Department of Surgery
 ( Kim Gwang-Il ) - Seoul National University Bundang Hospital Department of Internal Medicine
 ( Ahn So-Yeon ) - Seoul National University Bundang Hospital Medical Research Collaborating Center
 ( Kang Sung-Bum ) - Seoul National University Bundang Hospital Department of Surgery

Abstract


Purpose : This study was conducted to identify the effectiveness of a preoperative comprehensive geriatric assessment (CGA) for predicting postoperative morbidity in elderly patients who underwent surgery for colorectal cancer.

Methods : Elderly patients (≥70 years old) who underwent surgery for colorectal cancer at a tertiary hospital in Korea were identified, and their cases were analyzed using data from a prospectively collected database to establish an association between major postsurgical complications and 'high-risk' patient as defined by the CGA.

Results : A total of 240 patients, with a mean age of 76.7 ± 5.2 years, were enrolled. Ninety-five patients (39.6%) were classified as "high-risk" and 99 patients (41.3%) as having postoperative complications. The univariate analysis indicated that risk factors for postoperative complications were age, American Society of Anesthesiologists physical status classification, serum hemoglobin, carcinoembryonic antigen, cancer stage, and "high-risk" status. The multivariable analyses indicated that "high-risk" status (odds ratio, 2.107; 95% confidence interval, 1.168?3.804; P = 0.013) and elevated preoperative carcinoembryonic antigen (odds ratio, 2.561; 95% confidence interval, 1.346?4.871, P = 0.004) were independently associated with postoperative complications. A multivariable analysis of the individual CGA domains indicated that high comorbidities and low activities of daily living were significantly related with postoperative complications.

Conclusion : A preoperative CGA indicating "high-risk" was associated with major postoperative complications in elderly patients who underwent surgery for colorectal cancer. Thus, using the CGA to identify elderly colorectal-cancer patients who should be given more care during postoperative management may be clinically beneficial.

키워드

Colorectal neoplasms; Comprehensive geriatric assessment; Complication
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