Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Arun F, Arun O. Beyond oncological decisions: The missing perioperative link in comprehensive geriatric assessment for digestive system tumors. World J Gastrointest Oncol 2026; 18(12): 121386 [DOI: 10.4251/wjgo.121386]
World J Gastrointest Oncol. Dec 15, 2026; 18(12): 121386 Published online Dec 15, 2026. doi: 10.4251/wjgo.121386
Beyond oncological decisions: The missing perioperative link in comprehensive geriatric assessment for digestive system tumors
Funda Arun, Oguzhan Arun
Funda Arun, Anesthesiology Clinic, Department of Pedodontics, Selcuk University Faculty of Dentistry, Konya 42130, Türkiye
Oguzhan Arun, Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya 42130, Türkiye
Co-first authors: Funda Arun and Oguzhan Arun.
Author contributions: Arun F and Arun O contributed equally to the conceptualization, literature review, drafting, and critical revision of the manuscript as co-first authors; all authors have read and approved the final version of the manuscript.
AI contribution statement: Large language models (AI-based writing assistants) and Grammarly were utilized during the preparation of this manuscript. AI tools were strictly utilized as writing assistants for language polishing. They were used to improve English fluency, correct grammatical structures, ensure a neutral academic tone, and tighten the conciseness of the manuscript to meet the specific length and readability requirements requested by the peer reviewers. The core scientific concepts, intellectual arguments, clinical frameworks, and the overall structure of the editorial are entirely the original, human-generated work of the authors. AI was not used to generate novel ideas or original content.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Oguzhan Arun, MD, PhD, Professor, Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Alaaddin Keykubat Kampus, Konya 42130, Türkiye. oguzarun@selcuk.edu.tr
Received: March 25, 2026 Revised: April 14, 2026 Accepted: May 25, 2026 Published online: December 15, 2026 Processing time: 231 Days and 2.8 Hours
Abstract
Elderly patients undergoing major gastrointestinal oncological surgeries face profound biophysical stressors that traditional risk metrics often fail to capture. The recent study by Zhu and Liu published in World Journal of Gastrointestinal Oncology, represents a significant advancement in this field by utilizing the comprehensive geriatric assessment to individualize treatments and improve progression-free survival. However, while stratifying patients into ‘fit’, ‘vulnerable’, and ‘frail’ cohorts effectively optimizes preoperative systemic therapies, a critical gap remains in translating these strategic oncological decisions into actual surgical practice. This editorial advocates for expanding the multidisciplinary comprehensive geriatric assessment framework directly into the perioperative domain, with a specific focus on the ‘vulnerable’ subgroup. To successfully navigate the narrow therapeutic window of these patients, meticulous intraoperative management is imperative. By integrating advanced, goal-directed hemodynamic optimization – such as real-time tracking of fluid responsiveness – alongside immune-preserving anesthetic techniques and electroencephalogram-guided proactive neuroprotection, clinicians can actively mitigate severe surgical stress. Bridging this critical gap between oncological intent and physiological perioperative care is essential to minimize postoperative morbidity, maintain functional independence, and potentially enhance long-term survival outcomes in geriatric oncology.
Core Tip: While oncological planning for geriatric patients has become more granular through comprehensive geriatric assessment, its clinical impact is often limited by a lack of intraoperative integration. Meticulous surgical management for ‘vulnerable’ older adults must be directly linked to advanced perioperative medicine. This editorial emphasizes that adopting goal-directed hemodynamic optimization and immune-preserving anesthetic techniques can help mitigate surgical stress and reduce postoperative morbidity. This multidisciplinary approach ensures that strategic oncological intent is safely supported throughout the most critical physiological phase of the patient’s journey.
