Predicting Functional Recovery and Quality of Life in Older Patients Undergoing Colorectal Cancer Surgery: Real-World Data From the International GOSAFE Study
Authors: Montroni Isacco , Ugolini Giampaolo , Saur Nicole M. , Rostoft Siri , Spinelli Antonino , Van Leeuwen Barbara L. , De Liguori Carino Nicola , Ghignone Federico , Jaklitsch Michael T. , Kenig Jakub , Garutti Anna , Zingaretti Chiara , Foca Flavia , Vertogen Bernadette , Nanni Oriana , Wexner Steven D. , Audisio Riccardo A. ,   on behalf of the SIOG Surgical Task Force/ESSO GOSAFE Study Group, Taffurelli Giovanni , Zattoni Davide , Tramelli Paola , Sermonesi Giacomo , Ercolani Giorgio , Tauceri Francesca , Perenze Barbara , Di Pietrantonio Daniela , Mirarchi Mariateresa , Garulli Gianluca , Alagna Vincenzo , Lucchi Andrea , Pirrera Basilio , Monari Francesco , Conti Luigi , Capelli Patrizio , Romboli Andrea , Palmieri Gerardo , Banchini Filippo , Di Candido Francesca , Carvello Michele , Sacchi Matteo , De Lucia Francesca , Foppa Caterina , Marano Luigi , Spaziani Alessandro , Castagnoli Giampaolo , Bartoli Alberto , Frain Laura , Fox Sam W. , Cardin Kristin , De Leon Luis E. , Trompetto Mario , Gallo Gaetano , Realis Luc Alberto , Clerico Giuseppe , Sammarco Giuseppe , De Luca Raffaele , Simone Michele , Albano Anna , Fejka Michael , Bleier Joshua IS , Plas Matthijs , van der Wal-Huisman Hanneke , Costanzi Andrea , Mari Giulio , Maggioni Dario , Pellegrino Roberta , Riggio Valentina , Kenig Jakub , Szabat Kinga , Scabini Stefano , Pertile Davide , Epis Lorenzo , Massobrio Andrea , Soriero Domenico , Nesbakken Arild , Flåten Backe Ingeborg , Lønn Mariann , Ferrari Giovanni , Mazzola Michele , Magistro Carmelo , Achilli Pietro , Giani Alessandro , Ioannidis Orestis , Loutzidou Lydia , Galanos-Demiris Konstantinos , Pellino Gianluca , Balducci Genoveffa , Frezza Barbara , Lucarini Alessio , Santos Claudia , Cooper Lisa , Siam Baha , Levy Yochai , Brenner Baruch , Kashtan Hanoch , Belgrano Valerio , Decian Franco , Palermo Beatrice , Eggenhöffner Roberto , Albertelli Manuela , Sánchez-Guillén Luis , Arroyo Antonio , López-Rodríguez Francisco , Lario Sandra , Lillo Cristina , Baltatzis Minas , Chan Anthony K.C. , Siriwardena Ajith K. , Da Silva Giovanna 
Published: June 2023

PURPOSE The GOSAFE study evaluates risk factors for failing to achieve good quality of life (QoL) and functional recovery (FR) in older patients undergoing surgery for colon and rectal cancer. METHODS Patients age 70 years and older undergoing major elective colorectal surgery were prospectively enrolled. Frailty assessment was performed and outcomes, including QoL (EQ-5D-3L) recorded (3/6 months postoperatively). Postoperative FR was defined as a combination of Activity of Daily Living ≥5 + Timed Up & Go test <20 seconds + MiniCog >2. RESULTS Prospective complete data were available for 625/646 consecutive patients (96.9%; 435 colon and 190 rectal cancer), 52.6% men, and median age was 79.0 years (IQR, 74.6-82.9 years). Surgery was minimally invasive in 73% of patients (321/435 colon; 135/190 rectum). At 3-6 months, 68.9%-70.3% patients experienced equal/better QoL (72.8%-72.9% colon, 60.1%-63.9% rectal cancer). At logistic regression analysis, preoperative Flemish Triage Risk Screening Tool ≥2 (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) and postoperative complications (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) are associated with decreased QoL after colectomy. Eastern Collaborative Oncology Group performance status (ECOG PS) ≥2 is a strong predictor of postoperative QoL decline in the rectal cancer subgroup (OR, 3.81; 95% CI, 1.45 to 9.92; P = .006). FR was reported by 254/323 (78.6%) patients with colon and 94/133 (70.6%) with rectal cancer. 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 colon; OR, 4.61; 95% CI, 1.45 to 14.63; P = .009 rectal surgery), severe complications (OR, 17.33; 95% CI, 7.30 to 40.8; P < .001), fTRST ≥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) are risk factors for not achieving FR. CONCLUSION The majority of older patients experience good QoL and stay independent after colorectal cancer surgery. Predictors for failing to achieve these essential outcomes are now defined to guide patients' and families' preoperative counseling.