Impact of Comprehensive Geriatric Assessment on Treatment Strategies and Complications in Older Adults With Colorectal Cancer Considering Surgery

We have read with interest the article published by Sugiyama et al. [1]. In recent years, research on how to reduce postoperative complications in elderly patients with colorectal cancer has become a hot topic. This is a very meaningful study because it has a good guiding role in clinical practice. Although we believe it is a very interesting topic, we would like to offer the following points for your consideration. First, in Table 1, the medical history of lung diseases (such as chronic bronchitis, chronic obstructive pulmonary disease, and bronchial asthma) in both groups is not provided. Studies have shown that preoperative lung disease is an independent risk factor for postoperative complications in colorectal cancer [2, 3]. If patients have pre-existing pulmonary diseases, their lung function and compliance will decrease, and their tolerance to pneumoperitoneum will decrease, resulting in an increased incidence of postoperative pulmonary infections [4]. Second, in Table 1, the medical history of diabetes in the two groups is not provided. Some studies have shown that diabetes is an independent risk factor for postoperative complications of colorectal cancer [5, 6]. The increase in blood sugar can reduce the phagocytic ability of white blood cells and phagocytic cells, thereby lowering the body's defense capabilities. High blood sugar can lead to a decrease in the patient's protein synthesis ability and immune system, resulting in infections in wounds and other areas [7]. Therefore, controlling blood sugar during the perioperative period is particularly important. There is research showing that if postoperative blood sugar exceeds 40% of normal blood sugar, there will be a 30% increase in postoperative infectious complications [8]. Third, in Table 1, the body mass index (BMI) values of the two groups were not provided. Obesity can prolong the surgical time of laparoscopic colorectal resection, and longer surgical time can increase the incidence of postoperative incision infection [9]. There are also studies indicating that obesity is an independent risk factor for anastomotic leakage after left hemicolectomy [9, 10]. Qiang Hu drafted the letter and Xiyin Yang critically reviewed the article. This study was funded by Project of Traditional Chinese Medicine (No. 2024ZL345), Project of Zhejiang Provincial Department of Education (Y202351378). The authors declare no conflicts of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study. The data that support the findings of this study are available from the corresponding author upon reasonable request. We have read with interest the article published by Sugiyama et al. Although we believe it is a very interesting topic, we would like to offer the following points for your consideration.