Usefulness of the Geriatric Nutritional Risk Index (GNRI) as a Predictor of Postoperative Complications After Colorectal Cancer Surgery.

INTRODUCTION

Postoperative complications following colorectal cancer (CRC) surgery are known to not only impair patients' quality of life but also adversely affect long-term prognosis. Objective and simple preoperative risk assessment tools are essential for preventing such complications. The Geriatric Nutritional Risk Index (GNRI), which incorporates serum albumin concentration and the ratio of current to ideal body weight, has emerged as a useful tool for estimating the risk of postoperative complications and long-term prognosis in patients with CRC. However, detailed investigations into its association with specific postoperative complications remain limited.

METHODS

We retrospectively analyzed 105 consecutive patients who underwent CRC surgery between 2021 and 2023. Preoperative GNRI was calculated for each patient, and its association with postoperative complications was assessed. For comparison, the Prognostic Nutritional Index (PNI) and the Modified Glasgow Prognostic Score (mGPS) were also evaluated for postoperative complications.

RESULTS

Receiver operating characteristic (ROC) curve analysis identified a GNRI cutoff value of 94 for predicting complications of Clavien-Dindo grade ≥2. Patients in the high-risk group (GNRI <94) had a significantly higher incidence of grade ≥2 complications compared to the low-risk group (14/35 (40%) vs. 14/70 (20%); p=0.029). In multivariable analysis, after adjusting for known risk factors (age, sex, American Society of Anesthesiologists Physical Status (ASA-PS), preoperative obstruction, emergency surgery, surgical approach, and tumor stage), GNRI remained the only significant independent predictor (odds ratio 2.90; p=0.049). While rates of anastomotic leakage and wound infection did not differ significantly between groups, postoperative ileus (6/35 (17%) vs. 1/70 (1.4%); p=0.002) and delirium (4/35 (11%) vs. 1/70 (1.4%); p=0.023) were significantly more frequent in the high-risk group.

CONCLUSION

GNRI is a simple and effective tool for predicting postoperative complications in CRC patients. Preoperative nutritional assessment using GNRI may enhance perioperative safety and enable more personalized surgical care.