Clinical Report: Nutritional Status via SGA and Surgical Outcomes in Elderly Colorectal Cancer

Overview

This prospective study evaluated the utility of the Subjective Global Assessment (SGA) in assessing nutritional status and its impact on surgical outcomes in elderly colorectal cancer patients aged 75 and older. Findings demonstrated that malnutrition as assessed by SGA correlates with increased postoperative complications and influences prognosis.

Background

Cancer cachexia and invasive cancer treatments often lead to nutritional disorders, which adversely affect postoperative recovery and wound healing. Older patients are particularly vulnerable due to physiological, psychological, and social factors that impair nutrition. The SGA is a validated tool that assesses nutritional status comprehensively and has prognostic value in colorectal cancer. This study aimed to assess the SGA's usefulness in predicting surgical outcomes and prognosis in elderly colorectal cancer patients.

Data Highlights

Key Findings

• 39.4% of patients were well-nourished (SGA-A), while 60.6% were malnourished (SGA-B or C).
• Malnutrition assessed by SGA was associated with higher rates of postoperative complications.
• Most patients (83.1%) had a G8 score ≤14, indicating vulnerability in geriatric assessment.
• Minimally invasive surgery was performed in nearly all patients, with a median operative time of 230 minutes.
• One-third of patients required postoperative ICU care, often based on anesthesiologist discretion.
• Preoperative nutritional status as assessed by SGA is a useful prognostic indicator for elderly colorectal cancer patients undergoing surgery.

Clinical Implications

Preoperative nutritional assessment using the SGA should be integrated into the perioperative management of elderly colorectal cancer patients to identify those at risk of complications. Tailored nutritional interventions may improve postoperative recovery and outcomes. Additionally, combining SGA with geriatric assessments like G8 can enhance risk stratification and guide clinical decision-making.

Conclusion

The SGA is a valuable tool for evaluating nutritional status and predicting surgical outcomes in elderly colorectal cancer patients. Incorporating nutritional screening into routine preoperative evaluation can optimize perioperative care and improve prognosis.

References

1. Dewys et al. 1980 -- Cancer cachexia and nutritional disorders in cancer patients
2. Japanese Society of Colorectal Cancer 2020 -- Guidelines for colorectal cancer treatment
3. Detsky et al. 1987 -- Subjective Global Assessment of nutritional status
4. Kobayashi et al. 2021 -- Prognostic value of SGA in colorectal cancer
5. Bellera et al. 2012 -- Geriatric 8 screening tool in older cancer patients
6. Clavien et al. 2009 -- Clavien–Dindo classification of surgical complications
7. Dindo et al. 2004 -- Classification of surgical complications
8. Japanese Society of Colorectal Cancer 2019 -- Postoperative surveillance protocols
9. VanderWeele 2019 -- Modified disjunctive cause criterion for confounder selection