Key result
Major non-lethal postoperative complications after colorectal cancer resection significantly reduced overall survival (HR 2.42; 95% CI 1.41-4.14) but did not affect time to recurrence.
Why the study?
Do major postoperative complications after curative colorectal cancer resection affect long-term survival and time to recurrence?
Cohort (n=844)
Do major postoperative complications after curative colorectal cancer resection affect long-term survival and time to recurrence?
Hazard Ratio: 2.42 (95% CI 1.41–4.14)
Absolute Event Rate: 65% vs 78%
p-value: p=0.009
Non-lethal major postoperative complications following curative colorectal cancer resection significantly decrease long-term overall survival but do not affect time to recurrence.
Major complications after curative colorectal cancer resection were associated with worse outcomes; leaves open whether prevention improves survival or recurrence.
AIM: The aim of the study was to determine the effect of major complications after colorectal cancer surgery on survival and time to recurrence. METHOD: Patients having a curative colorectal cancer resection and a follow-up of at least 3 years were identified from a prospective database. Major complications were defined as Clavien-Dindo Grades 3b or 4 and their impact on time to recurrence and mortality was analysed by univariate and multivariable analysis. Postoperative death within 30 days or during the initial hospitalization (Clavien-Dindo Grade 5) was a priori excluded. RESULTS: From 2003 to 2012, 868 colorectal cancer resections resulting in 63 (7%) major postoperative complications including deaths (Clavien-Dindo ≥ 3b) were identified. After exclusion of Grade 5 complications (postoperative or in-hospital deaths), 844 resections with 39 (5%) major complications remained for analysis. Median follow-up time was 5.7 years. Using the Kaplan-Meier method, the estimated crude 5-year overall survival probability was 78% (95% CI 75-81) in the group without and 65% (95% CI 51-83) in the group with major complications (P = 0.009, log-rank test). Major complications were a significant negative predictor for overall survival (hazard ratio 2.42, 95% CI 1.41-4.14) when adjusted for sex, age, American Society of Anesthesiologists grade, tumour site (colon vs rectum), R stage and tumour stage. However, in both univariate and multivariable analysis, major complications were not a significant predictor for time to recurrence (hazard ratio 1.29, 95% CI 0.56-2.99). CONCLUSION: Non-lethal major postoperative complications seem to have a negative long-term impact on survival but not on time to recurrence.
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Odermatt et al. (2014) conducted a cohort in Colorectal cancer (n=844). Major postoperative complications (Clavien-Dindo Grades 3b or 4) vs. No major complications was evaluated on 5-year overall survival (HR 2.42, 95% CI 1.41-4.14, p=0.009). Major non-lethal postoperative complications after colorectal cancer resection significantly reduced overall survival (HR 2.42; 95% CI 1.41-4.14) but did not affect time to recurrence.
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