For a GOSAFE study, researchers sought to assess risk factors influencing the failure to achieve favorable outcomes in quality of life (QoL) and functional recovery (FR) among older patients aged [70 years and older] undergoing major elective colorectal surgery.
Patients aged [70 years and older] undergoing major elective colorectal surgery were prospectively enrolled in the study. A comprehensive frailty assessment was conducted, and outcomes, specifically the quality of life (QoL) using EQ-5D-3L, were recorded postoperatively at [3/6 months]. Postoperative functional recovery (FR) was defined as the confluence of three criteria: Activity of Daily Living ≥5 + Timed Up & Go test <20 seconds, and MiniCog >2.
Prospective complete data were obtained for [625/646] consecutive patients (96.9%), comprising [435] with colon cancer and [190] with rectal cancer. The cohort consisted of [52.6%] men, with a median age of [79.0 years] (IQR, [74.6-82.9] years). Minimally invasive surgery was performed in [73%] of patients, with [321/435] having colon surgery and [135/190] rectal surgery. At the [3-6 months] follow-up, [68.9%-70.3%] of patients reported equal or improved quality of life (QoL), with [72.8%-72.9%] in the colon cancer subgroup and [60.1%-63.9%] in the rectal cancer subgroup. Logistic regression analysis revealed that a preoperative Flemish Triage Risk Screening Tool ≥2 was associated with decreased QoL after colectomy (3-month odds ratio [OR], 1.68; 95% CI, 1.04 to 2.73; P = .034; 6-month OR, 1.71; 95% CI, 1.06 to 2.75; P = .027). Postoperative complications were also linked to decreased QoL (3-month OR, 2.03; 95% CI, 1.20 to 3.42; P = .008; 6-month OR, 2.56; 95% CI, 1.15 to 5.68; P = .02). In the rectal cancer subgroup, an Eastern Collaborative Oncology Group performance status (ECOG PS) ≥2 strongly predicted postoperative QoL decline (OR, 3.81; 95% CI, 1.45 to 9.92; P = .006). Functional recovery (FR) was reported by [254/323 (78.6%)] patients with colon cancer and [94/133 (70.6%)] with rectal cancer. Risk factors for not achieving FR included a Charlson Age Comorbidity Index ≥7 (OR, 2.59; 95% CI, 1.26 to 5.32; P = .009), ECOG ≥2 (OR, 3.12; 95% CI, 1.36 to 7.20; P = .007 for colon; OR, 4.61; 95% CI, 1.45 to 14.63; P = .009 for rectal surgery), severe complications (OR, 17.33; 95% CI, 7.30 to 40.8; P < .001), Flemish Triage Risk Screening Tool ≥2 (OR, 2.71; 95% CI, 1.40 to 5.25; P = .003), and palliative surgery (OR, 4.11; 95% CI, 1.29 to 13.07; P = .017).
Most older patients achieved good QoL and maintained independence after colorectal cancer surgery. Predictors for failure to achieve these outcomes, including preoperative screening and postoperative complications, were identified, providing essential guidance for preoperative counseling of patients and their families.
