{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:56:12Z","timestamp":1790668572854,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP25K12003"],"award-info":[{"award-number":["JP25K12003"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Gastroent Surgery"],"abstract":"ABSTRACT<\/jats:title>\n \n Aim<\/jats:title>\n Surgical outcomes for colorectal cancer (CRC) in nonagenarians remain uncertain due to frailty, comorbidities, and malnutrition. The Geriatric Nutritional Risk Index (GNRI) is associated with surgical outcomes in older patients with CRC, but its prognostic value in nonagenarians is unclear. This study evaluated the GNRI's predictive value for short\u2010 and long\u2010term surgical outcomes in this population.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively analyzed 225 nonagenarians undergoing surgical resection of CRC at 15 institutions between 2011 and 2022. Patients were stratified by GNRI\u2010high\/low status using two cutoffs: 98 (Cohort 1) and 86 (Cohort 2). Outcomes included postoperative complications, length of hospital stay, and overall survival (OS). Stabilized inverse\u2010probability\u2010of\u2010treatment weighting (IPTW) was used to adjust for measured confounding.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The median age was 92\u2009years (female, 64.9%; colon cancer, 79.6%). GNRI\u2010high patients had higher body mass index and albumin levels. Complication rates did not differ between the groups. After adjustment, GNRI\u2010high patients in Cohort 1 had a shorter expected hospital stay (ratio 0.70, 95% CI 0.51\u20130.96;\n p<\/jats:italic>\n \u2009=\u20090.025) but no significant OS difference. In Cohort 2, GNRI\u2010high patients had better OS (\n p<\/jats:italic>\n \u2009<\u20090.01), confirmed by adjusted Cox models (HR 0.54, 95% CI 0.35\u20130.82;\n p<\/jats:italic>\n \u2009<\u20090.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Preoperative GNRI was associated with hospital stay and OS in nonagenarians undergoing CRC surgery, although the OS association was significant only with the cohort\u2010derived cutoff of 86, which requires external validation, and not with the literature\u2010based cutoff of 98. The GNRI is a simple tool to stratify surgical risk and optimize perioperative nutritional status in this vulnerable population.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ags3.70288","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:13:46Z","timestamp":1790666026000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Geriatric Nutritional Risk Index Predicts Short\u2010 and Long\u2010Term Outcomes in the Oldest\u2010Old With Colorectal Cancer: A Multi\u2010Institutional Analysis of 225 Nonagenarians"],"prefix":"10.1002","author":[{"given":"Toshiaki","family":"Toshima","sequence":"first","affiliation":[{"name":"Department of Surgery Kagawa Rosai Hospital Kagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5133-2644","authenticated-orcid":false,"given":"Fuminori","family":"Teraishi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Okayama University Hospital Okayama Japan"},{"name":"Department of Surgery National Hospital Organization Fukuyama Medical Center Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoe","family":"Takanaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Okayama University Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9940-0570","authenticated-orcid":false,"given":"Toshiharu","family":"Mitsuhashi","sequence":"additional","affiliation":[{"name":"Center for Innovative Clinical Medicine, Medical Development Field Okayama University Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4452-6480","authenticated-orcid":false,"given":"Ryo","family":"Inada","sequence":"additional","affiliation":[{"name":"Department of Surgery Kochi Health Sciences Center Kochi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Ohtani","sequence":"additional","affiliation":[{"name":"Department of Surgery Saiseikai Okayama Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Surgery Okayama Rosai Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Hori","sequence":"additional","affiliation":[{"name":"Department of Surgery Tottori Municipal Hospital Tottori Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaoru","family":"Shigemitsu","sequence":"additional","affiliation":[{"name":"Department of Surgery Tsuyama Chuo Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumiharu","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Surgery Okayama City Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsushi","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Surgery Kobe Red Cross Hospital Kobe Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuka","family":"Okano","sequence":"additional","affiliation":[{"name":"Department of Surgery Onomichi City Hospital Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuji","family":"Nobuhisa","sequence":"additional","affiliation":[{"name":"Department of Surgery Himeji Red Cross Hospital Himeji Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumitaka","family":"Taniguchi","sequence":"additional","affiliation":[{"name":"Department of Surgery National Hospital Organization Iwakuni Clinical Center Yamaguchi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Surgery Fukuyama City Hospital Hiroshima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryohei","family":"Shoji","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Okayama University Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuo","family":"Matsuda","sequence":"additional","affiliation":[{"name":"Department of Surgery Matsuda Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuo","family":"Umeoka","sequence":"additional","affiliation":[{"name":"Department of Surgery Matsuyama City Hospital Matsuyama Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiyoshi","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological Surgery Okayama University Hospital Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The Setouchi Colorectal Neoplasm Registration Study Group Collaborators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","first-page":"12","article-title":"Cancer Statistics, 2024","volume":"74","author":"Siegel R. 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T.","year":"2021","journal-title":"Journal of Cachexia, Sarcopenia and Muscle"},{"issue":"4","key":"e_1_2_12_31_1","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.21873\/invivo.13265","article-title":"Impact of Preoperative Nutritional Status on Long\u2010Term Survival in Patients With Stage I\u2010III Colorectal Cancer","volume":"37","author":"Shibutani M.","year":"2023","journal-title":"In Vivo"},{"issue":"6","key":"e_1_2_12_32_1","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1002\/jcsm.12776","article-title":"Prevalence and Prognostic Impact of Cachexia Among Older Patients With Cancer: A Nationwide Cross\u2010Sectional Survey (NutriAgeCancer)","volume":"12","author":"Poisson J.","year":"2021","journal-title":"Journal of Cachexia, Sarcopenia and Muscle"},{"key":"e_1_2_12_33_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jgo.2024.101837","article-title":"Comprehensive Geriatric Assessment as an Indicator of Postoperative Recovery in Older Patients With Colorectal Cancer","volume":"15","author":"Teraishi F.","year":"2024","journal-title":"Journal of Geriatric Oncology"}],"container-title":["Annals of Gastroenterological Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70288","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ags3.70288","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ags3.70288","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:13:51Z","timestamp":1790666031000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ags3.70288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":32,"alternative-id":["10.1002\/ags3.70288"],"URL":"https:\/\/doi.org\/10.1002\/ags3.70288","archive":["Portico"],"relation":{},"ISSN":["2475-0328","2475-0328"],"issn-type":[{"value":"2475-0328","type":"print"},{"value":"2475-0328","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"assertion":[{"value":"2026-03-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ags3.70288"}}