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

Yamamoto, Masaaki; Yamasaki, Makoto; Sugimoto, Ken; Maekawa, Yoshihiro; Miyazaki, Yasuhiro; Makino, Tomoki; Takahashi, Tsuyoshi; Kurokawa, Yukinori; Nakajima, Kiyokazu; Takiguchi, Shuji; Rakugi, Hiromi; Mori, Masaki; Doki, Yuichiro

doi:10.1007/s00268-016-3602-2

Cited by 34 publications

(44 citation statements)

References 38 publications

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“…The authors found that body mass index, ASA classification, and comorbidity did not predict complications independently, while nutritional risk was an independent predictor of complications. In a Japanese study in 91 patients older than 75 years who underwent esophagectomy for esophageal cancer, the association between GA variables and postoperative delirium was investigated [39]. Postoperative delirium was significantly associated with preoperative cognitive impairment and depression.…”

Section: Geriatric Assessment and Gastroesophageal Cancermentioning

confidence: 99%

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Rostoft

2017

Visc Med

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Background: The majority of patients with gastrointestinal (GI) malignancies are older. Recently, it has become evident that elements from a geriatric assessment (GA) are powerful predictors of outcomes such as postoperative morbidity and mortality, length of stay, type of treatment received, and survival across several GI tumor types in older adults. A GA is a systematic evaluation of functional status, comorbidities, polypharmacy, cognition, nutritional status, emotional status, and social support. Methods: A PubMed search was performed in order to identify clinical studies investigating the association between GA and outcomes in patients with GI malignancies. Results: A total of 31 studies were included in this review. For colorectal cancer, the evidence linking GA variables and frailty to negative outcomes is substantial and consistent. The data regarding other GI malignancies is more limited, but generally shows the same findings. Conclusion: Increasing data shows that elements from a GA and frailty are consistently associated with negative short- and long-term treatment outcomes in older patients with GI malignancies. Future studies should investigate the impact of geriatric interventions on outcomes.

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Section: Geriatric Assessment and Gastroesophageal Cancermentioning

confidence: 99%

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Rostoft

2017

Visc Med

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“…In this study, a one point decrease in MMSE score associated with a 40% increased risk of delirium (odds ratio (OR) 1.4 (95% CI 1.2-1.6)) [28]. Depressive symptoms were measured with the Hospital Anxiety and Depression Scale (HADS) [24] and the Geriatric Depression Scale fifteen (GDS15) [28]. One study reported a prevalence of 42% patients having depressive symptoms.…”

Section: Prolonged Length Of Stay (Los)mentioning

confidence: 88%

“…In this study 24 of the 91 individuals developed postoperative delirium and these patients had a lower mean MMSE score of 23 compared to 27 in patients without delirium, indicating a lower cognitive status. In this study, a one point decrease in MMSE score associated with a 40% increased risk of delirium (odds ratio (OR) 1.4 (95% CI 1.2-1.6)) [28]. Depressive symptoms were measured with the Hospital Anxiety and Depression Scale (HADS) [24] and the Geriatric Depression Scale fifteen (GDS15) [28].…”

Section: Prolonged Length Of Stay (Los)mentioning

confidence: 91%

“…Nine of the associations reporting on overall functional performance used the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 [18][19][20][21][22][23], four used the Karnofsky Performance Score (KPS) [18,21,24,25], six used the Eastern Cooperative Oncology Group (ECOG) score, three used the Zubrod performance score [26,27] and two used Barthel index and Instrumental Activities of Daily Living (IADL) [28]. Functional impairment was prevalent in most of the studies with rates between 14 and 67%.…”

Section: Functional Impairment and Physical Impairmentmentioning

confidence: 99%

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Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review

Deudekom

Klop

Hartgrink

et al. 2018

Journal of Geriatric Oncology

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“…Treatment decisions should be made individually and with appropriate caution in older patients. A preoperative geriatric assessment is advisable to obtain a holistic view of the patient, which can give insight in the risk of postoperative complications, such as delirium …”

Section: Patient Selection For Surgerymentioning

confidence: 99%

Surgical treatment of esophageal cancer in the era of multimodality management

Borggreve

Kingma

Домрачев

et al. 2018

Annals of the New York Academy of Sciences

115

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Over the last decades, the treatment of resectable esophageal cancer has evolved into a multidisciplinary process in which all players are essential for treatment to be successful. Medical oncologists and radiation oncologists have been increasingly involved since the implementation of neoadjuvant therapy, which has been shown to improve survival. Although esophagectomy is still considered the cornerstone of curative treatment for locally advanced esophageal cancer, it remains associated with considerable postoperative morbidity, despite promising results of minimally invasive techniques. In this light, both physical status and response to neoadjuvant therapy may be important factors for selecting patients who will benefit from surgery. Furthermore, it is important to optimize the entire perioperative trajectory: from the initial outpatient clinic visit to postoperative discharge. Enhanced recovery after surgery is increasingly recognized for esophagectomy and emphasizes perioperative aspects, such as nutrition, physiotherapy, and pain management. To date, several facets of esophageal cancer treatment remain topics of debate, such as the preferred neoadjuvant treatment, anastomotic technique, extent of lymphadenectomy, organization of postoperative care, and the role of surgery beyond locally advanced disease. Here, we describe the current and future perspectives in the surgical treatment of patients with esophageal cancer in the context of the available literature.

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

Abstract: 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.

Cited by 34 publications

References 38 publications

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Integration of Geriatric Assessment in the Care of Patients with Gastrointestinal Malignancies

Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review

Surgical treatment of esophageal cancer in the era of multimodality management

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