EP465 - Preoperative Geriatric Assessment And Tailored Interventions In Elderly Colorectal Cancer Surgery: A Systematic Review And Meta-Analysis Of Postoperative Outcomes

Purpose/Background: Colorectal Cancer (CRC) is a leading cause of cancer-related morbidity and mortality. While surgery remains the standard of care, geriatric patients face greater risk of adverse postoperative outcomes. Preoperative geriatric assessment (GA) is a comprehensive, multidimensional evaluation of an older patient's medical, psychological, nutritional, functional and social domains, aimed at uncovering modifiable risk factors. It has shown value in risk prediction of treatment-related complications in oncology and the potential to optimize postoperative outcomes through tailored interventions. This systematic review and meta-analysis (SRMA) aims to evaluate the impact of preoperative GA with tailored interventions on postoperative complications in elderly colorectal cancer patients.

Methods/Interventions: This SRMA was conducted according to PRISMA guidelines and registered on PROSPERO (CRD42025629992). PubMed, Embase and Cochrane Library were searched from inception to 19 August 2024. Cohort studies and RCTs of patients >65 years undergoing CRC surgery were included if they evaluated the association between preoperative GA with tailored interventions and postoperative complications. Random-effects meta-analyses were performed in R (v4.4.2) with the meta package. Binary outcomes were reported as risk ratios (RR) with 95% confidence intervals (CI), and continuous outcomes as weighted mean differences (MD) with 95% CIs. Heterogeneity was assessed using the I² statistic. Risk of bias was assessed with ROB-2 for randomized studies and the Newcastle-Ottawa Scale for non-randomized studies.

Results/Outcomes: Ten studies met inclusion criteria, including five direct-comparison studies (GA + tailored interventions vs usual care) and five frailty-stratified studies (frail patients received GA + tailored interventions vs fit patients with usual care). In direct-comparison studies, 363 (51.9%) patients received preoperative GA and 337 (48.1%) received usual care, totaling 700 patients. Preoperative GA was not associated with significant differences in 30-day overall morbidity (total Clavien-Dindo complications, RR = 1.45 [0.15 - 13.60]), 30-day major complications (Clavien-Dindo ≥3, RR = 1.36 [0.23 - 8.09]), 30-day mortality (RR = 0.98 [0.29 - 3.36]) and ileus (RR = 1.34 [0.54 - 3.37]). In frailty-stratified studies, 499 patients (40.4%) received preoperative GA and 736 (59.6%) received usual care, totaling 1235 patients. No significant differences were observed in 30-day major complications (Clavien-Dindo ≥3, RR = 1.07 [0.58 - 1.99]), 30-day mortality (RR = 1.46 [0.48 - 4.42]), 30-day readmission (RR = 1.03 [0.68 - 1.57]), reoperation (RR = 1.16 [0.37 - 3.71]), anastomotic leak (RR = 0.60 [0.04 - 9.16]), delirium (RR = 1.37 [0.35 - 5.35]) and length of stay (MD = 0.47 [-1.48 - 2.42]).

Conclusion/Discussion: While preoperative GA with tailored interventions did not influence short-term postoperative complications, the absence of significant differences within frailty-stratified studies suggest that they may attenuate the excess surgical risks associated with frailty. These findings are limited by the variability in components of GA, thresholds for intervention, extent of interventions and any involvement of wider protocols. The value of GA on functional outcomes also warrants assessment. While integrating GA in geriatric colorectal cancer remains appropriate, larger prospective trials can be done to determine which patients benefit most from it and more clearly ascertain its impact on postoperative outcomes.

Table 1: Study and Patient Characteristics
Table 2: Summary of Pooled Postoperative Outcomes