Preoperative geriatric assessment and tailored interventions in frail older patients with colorectal cancer: a randomized controlled trial

Aim

Colorectal cancer (CRC) is prevalent in the older population, and surgery is the mainstay of curative treatment. A preoperative geriatric assessment (GA) can identify frail older patients at risk for developing postoperative complications. In this randomized controlled trial we wanted to investigate whether tailored interventions based on a preoperative GA could reduce the frequency of postoperative complications in frail patients operated on for CRC.

Method

Patients > 65 years scheduled for elective CRC surgery and fulfilling predefined criteria for frailty were randomized to either a preoperative GA followed by a tailored intervention or care as usual. The primary end‐point was Clavien–Dindo Grade II–V postoperative complications. Secondary end‐points included complications of any grade, reoperation, length of stay, readmission and survival.

Results

One hundred and twenty‐two patients with a mean age of 78.6 years were randomized. We found no statistically significant differences between the intervention group and the control group for Grade II–V complications (68% vs 75%, P = 0.43), reoperation (19% vs 11%, P = 0.24), length of stay (8 days in both groups), readmission (16% vs 6%, P = 0.12) or 30‐day survival (4% vs 5%, P = 0.79). Grade I–V complications occurred in 76% of patients in the intervention group compared with 87% in the control group (P = 0.10). In secondary analyses adjusting for prespecified prognostic factors, there was a statistically significant difference in favour of the intervention for reducing the total number of Grade I–V complications (P = 0.05).

Conclusion

A preoperative GA and tailored interventions did not reduce the rate of Grade II–V complications, reoperations, readmission or mortality in frail older patients electively operated on for CRC.