Page 24 - Risk quantification and modification in older patients with colorectal cancer

Chapter 2
Abstract
Background: An increasing number of patients with Colorectal Cancer (CRC) is 65 years or older. We aimed to systematically review existing clinical prediction models for postoperative outcomes of CRC surgery, study their performance in older patients and assess their potential for preoperative decision making.
Methods: A systematic search in Pubmed and Embase for original studies of clinical prediction models for outcomes of in colorectal surgery. Bias and relevance for preoperative decision making with older patients were assessed using the CHARMS guidelines.
Results: 26 prediction models from 25 publications were included. The average age of included patients ranged from 61 to 76. Two models were exclusively developed for patients of 65 and older. Common outcomes were mortality (n=10), anastomotic leakage (n=7) and surgical site infections (n=3). No prediction models for quality of life or physical functioning were identified. Age, gender and ASA score were common predictors; 12 studies included intraoperative predictors. For the majority of the models, bias for model development and performance was considered moderate to high.
Conclusions: Prediction models are available that address mortality and surgical complications after colorectal surgery. Most models suffer from methodological limitations, and their performance for older patients is uncertain. Models that contain peri-operative predictors are of limited use for preoperative decision making. Future research should address the predictive value of geriatric characteristics to improve the performance of prediction models for older patients.
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