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 CRC 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 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 CRC surgery. Most models suffer from methodological limitations, and their performance for older patients is uncertain. Models that contain intraoperative 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.

中文翻译：

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老年人群结直肠癌手术术后风险预测模型-系统评价。

背景

越来越多的65岁以上的大肠癌（CRC）患者。我们旨在系统地审查现有的CRC手术术后结局的临床预测模型，研究其在老年患者中的表现，并评估其在术前决策中的潜力。

方法

在Pubmed和Embase中系统搜索CRC手术结果的临床预测模型的原始研究。使用CHARMS指南评估老年患者术前决策的偏倚和相关性。

结果

包括来自25个出版物的26个预测模型。纳入患者的平均年龄为61至76岁。专门针对65岁及65岁以上的人群开发了两种模型。常见的结果是死亡率（n  = 10），吻合口漏（n  = 7）和手术部位感染（n  = 3）。没有确定生活质量或身体机能的预测模型。年龄，性别和ASA评分是常见的预测指标；12项研究包括术中预测因素。对于大多数模型，模型开发和性能的偏差被认为是中等到很高。

结论

可以使用预测模型来解决CRC手术后的死亡率和手术并发症。大多数模型都受到方法学上的限制，并且对于老年患者的表现尚不确定。包含术中预测因子的模型在术前决策中用途有限。未来的研究应探讨老年特征的预测价值，以改善老年患者预测模型的性能。