Journal Article

The Geriatric Nutritional Risk Index: A Key Indicator of Perioperative Outcome in Oldest-old Patients With Colorectal Cancer

ITAGAKI, SHIORI, SHOJI, RYOHEI, SHIGEYASU, KUNITOSHI, KONDO, YOSHITAKA, INAGAKI, MASARU, MATSUOKA, YOSHIKAZU, YOSHIDA, YUSUKE, MATSUMI, YUKI, UTSUMI, MASASHI, TAMURA, RIE, FUJIWARA, TOSHIYOSHI, KANAYA, NOBUHIKO, TERAISHI, FUMINORI

2025

Overview

Colorectal cancer (CRC) presents a significant challenge in oldest-old patients (≥85 years), where surgical intervention carries substantial perioperative risks. Nutritional status is a crucial determinant of outcomes, and the Geriatric Nutritional Risk Index (GNRI) has shown promise. This prospective study aimed to validate the GNRI as a key indicator of perioperative outcomes in oldest-old patients undergoing CRC surgery, and to establish its utility in preoperative risk stratification. This prospective study enrolled patients aged ≥85 years undergoing elective surgery for CRC. Preoperative GNRI was calculated using the formula: GNRI=14.89×serum albumin (g/dl)+41.7×[actual body weight/ideal body weight (corresponding to body mass index 22)]. Patients were stratified into two groups: GNRI >98 and GNRI ≤98. Baseline demographics, clinical characteristics, geriatric assessments (including Geriatric-8 and EuroQol 5 dimension), and postoperative complication rates were analyzed. Twenty-four patients (median age 88 years, interquartile range=86-91) were included: 11 in the GNRI >98 group and 13 in the GNRI ≤98 group. The patients with GNRI >98 demonstrated significantly better G8 scores (median 12 11, <0.01) and EQ-5D index values (median 88 75.0, <0.01). The postoperative complication rate was significantly higher in the GNRI ≤98 group ( =0.02). Preoperative GNRI effectively identifies oldest-old patients with CRC at increased risk for postoperative complications. A GNRI ≤98 correlates with poorer nutritional status and impaired geriatric functional parameters. These findings highlight GNRI's utility as a simple, valuable tool for preoperative risk stratification, potentially guiding interventions to optimize outcomes in this vulnerable population.

• Publisher: International Institute of Anticancer Research
• Subject: Abscesses / Activities of daily living / Aged, 80 and over / Body mass index / Clinical outcomes / Colorectal cancer / Colorectal Neoplasms - epidemiology / Colorectal Neoplasms - surgery / Delirium / Elective Surgical Procedures / Ethics / Female / Geriatric Assessment - methods / Geriatrics / Hospitals / Humans / Laparoscopy / Male / Nutrition Assessment / Nutritional Status / Observational studies / Older people / Patients / Perioperative care / Perioperative Period / Postoperative Complications / Prospective Studies / Proteins / Quality of life / Questionnaires / Risk Assessment / Risk Factors / Surgery / Surgical outcomes