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

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.

Assessment potential of a new suture simulator in laparoscopic surgical skills training.

BACKGROUND: The skills necessary for performing effective laparoscopic suturing are difficult to acquire; as a result, simulators for learning these skills are rapidly becoming integrated into surgical training. The aim of the study was to verify whether a new hybrid simulator has the potential to measure skill improvement in young, less experienced gastroenterological surgeons. MATERIAL AND METHODS: The study included 12 surgeons (median age, 29 (27-38)] years; 11 men (91.7%), one woman (8.3%)) who participated in a two-day laparoscopic training seminar. We used the new simulator before and after the program to evaluate individual performance. Skills were evaluated using five criteria: volume of air pressure leakage, number of full-thickness sutures, suture tension, wound area, and performance time. RESULTS: Air pressure leakage was significantly higher after than before the training (p = .027). The number of full-thickness sutures was significantly higher post-training (p < .01). Suture tension was significantly less post-training (p = .011). Wound opening areas were significantly smaller post-training (p = .018). Performance time was significantly shorter post-training (p = .032). CONCLUSIONS: Our study demonstrated the assessment quality of this new laparoscopic suture simulator.

Prediction of Postoperative Complications Following Elective Surgery in Elderly Patients with Colorectal Cancer Using the Comprehensive Geriatric Assessment.

AIMS: The study aims to determine whether the Comprehensive Geriatric Assessment (CGA) could predict complications of colorectal cancer (CRC) surgery and identify the problems. So we compared the prognostic value of the CGA with patient characteristics and determined predictive scores. METHODS: A total of 156 patients aged 75 years and older, who underwent surgery for CRC at Osaka University Hospital, were enrolled. Each patient was examined by the CGA prospectively, and all postoperative complications were obtained from the medical records. The CGA included the Barthel Index (BI), Vitality Index, instrumental activities of daily living (iADL), Mini-Mental State Examination (MMSE) and Geriatric Depression Score (GDS). All elements were retrospectively compared in patients with or without postoperative complications, including delirium, surgical site infection and ileus. RESULTS: Overall, postoperative complications developed in 76 patients (48.7%). The BI and MMSE were associated with the incidence of complications, and BI, iADL, MMSE and GDS were significantly related with delirium. Multivariate logistic analysis identified the MMSE as a significant determinant of postoperative complications after adjusting for other determined predictive scores including the prognostic nutritional index and performance status. CONCLUSION: The CGA was a useful predictor of postoperative complications in elderly patients when administered before surgery for CRC.

Risk Evaluation of Postoperative Delirium Using Comprehensive Geriatric Assessment in Elderly Patients with Esophageal Cancer.

BACKGROUND: The number of geriatric patients with esophageal cancer is increasing in step with the aging of the population. Geriatric patients have a higher risk of postoperative complications, including delirium that can cause a fall or impact survival. Therefore, it is very important that we evaluate risks of postoperative complications before surgery. The aim of this study was to predict postoperative delirium in elderly patients. METHODS: We retrospectively reviewed the medical records of 91 patients aged 75 years and over who underwent esophagectomy between January 2006 and December 2014. We investigated the association between postoperative delirium and clinicopathological factors, including comprehensive geriatric assessment (CGA). RESULTS: Postoperative delirium developed in 24 (26 %) patients. Postoperative delirium was significantly associated with low mini-mental state examination (MMSE) and high Geriatric Depression Scale 15 (GDS15), which are components of CGA, and psychiatric disorder (P < 0.0001, P = 0.002, and P = 0.017, respectively). With multiple logistic regression analysis, MMSE (odds ratio [OR], 1.4; 95 % confidence interval [CI], 1.2-1.6; P < 0.0001] and GDS15 (OR, 1.3; 95 % CI, 1.1-1.6; P = 0.004) were independently associated with postoperative delirium. CONCLUSIONS: Preoperative CGA, especially MMSE and GDS15, was useful for predicting postoperative delirium in elderly patients undergoing esophagectomy for esophageal cancer. Intervention by a multidisciplinary team using CGA might help prevent postoperative delirium.

Comprehensive Geriatric Assessment is a useful predictive tool for postoperative delirium after gastrointestinal surgery in old-old adults.

AIM: To determine whether carrying out the Comprehensive Geriatric Assessment before operations would be useful for predicting complications, particularly postoperative delirium (POD), in old-old patients. METHODS: A total of 517 patients aged 75 years and older, who underwent radical surgery for gastrointestinal cancer at Osaka University Hospital, were recruited for this observational study. The Comprehensive Geriatric Assessment components and assessment of performance status were carried out before surgery, and a record of postoperative complications including POD was made prospectively until discharge from hospital. The following morphological and clinical measurements were also obtained from the medical records: age, sex, disease type, previous history, comorbid lifestyle-related diseases, POD, postoperative complications, operative method, duration of operation, hemorrhage volume, blood transfusion volume, method of anesthesia, body mass index and blood tests. RESULTS: POD appeared in 24.0% of the 517 patients who underwent surgery. Barthel Index, Mini-Mental State Examination, instrumental activities of daily living and Geriatric Depression Scale results were associated with the incidence of POD, and the Barthel Index, Mini-Mental State Examination and Instrumental Activities of Daily Living results were extracted as independent factors associated with the development of POD after adjusting for traditional risk factors for postoperative complications and performance status. CONCLUSIONS: The Comprehensive Geriatric Assessment before gastrointestinal surgery can be a useful tool for predicting the development of POD in old-old patients. Geriatr Gerontol Int 2016; 16: 1036-1042.

Assessment of stanniocalcin-1 as a prognostic marker in human esophageal squamous cell carcinoma.

Stanniocalcin-1 (STC1) is a secreted glycoprotein hormone and highly expressed in various types of human malignancies. Although evidence points to the role of STC1 in human cancers, the clinical significance of STC1 expression in esophageal cancer has not been well established. Quantitative reverse transcriptase-polymerase chain reaction and immunohistochemistry were performed to assess the expression of STC1 in the cancer cell line TE8 and esophageal cancer tissues from 229 esophageal squamous cell carcinomas (ESCC). Surgically-resected tissue sections were immunostained for potential regulators of STC1 expression, hypoxia-inducible factor-1α (HIF-1α) and p53. Marked increase in STC1 mRNA and protein expression was noted in TE8 cells cultured under hypoxic conditions. Overexpression of STC1 mRNA was noted in ESCC tumors compared to normal counterparts. Positive immunohistochemical staining for STC1 protein was observed in 38.9% of patients, and correlated significantly with advanced pT status (p=0.019), poor prognosis [overall survival (p<0.0006) and disease-free survival (p<0.0002) of ESCC patients who had undergone curative surgery]. Positive staining for HIF-1α and p53 proteins in ESCC did not correlate with STC1 expression. The results showed marked induction of STC1 expression under hypoxia in cultured cells and in esophageal cancer cells and that overexpression of STC1 was an independent prognostic factor in patients with esophageal cancer who had undergone curative surgery. STC1 is a potentially useful biomarker for ESCC treatment.