Impact of type and severity of postoperative complications on long‐term outcomes after colorectal liver metastases resection

Abstract

Background and Objectives Postoperative complications (POCs) after hepatic resection for colorectal liver metastases (CRLM) adversely affect long‐term survival. The aim of this study was to analyze the effect of POC etiology and severity on overall survival (OS) and disease‐free survival (DFS). Methods A retrospective study of 254 consecutive hepatectomies for CRLM was performed. Univariate and multivariate analyses were performed to determine the effects of demographic, tumor‐related and perioperative variables on OS and DFS. A 1:1 propensity score matching (PSM) was then used to compare patients with different POC etiology: infective (Inf‐POC), noninfective (Non‐inf POC), and no‐complications (No‐POC). Results Inf‐POC, Non‐inf POC, and No‐POC patients represented 18.8%, 19.2%, and 62% of the sample, respectively. In univariate and multivariate analyses infectious POC were independent risk factors for decreased OS and DFS. After PSM, Inf‐POC group presented decreased OS and DFS when compared with Non‐inf POC (5‐year OS 31.8% vs 51.6%; P = .05 and 5‐year DFS 13.6% vs 31.9%; P = .04) and with No‐POC (5‐year OS 29.4% vs 58.7%; P = .03 and 5‐year DFS 11.8% vs 39.7%; P = .03). There were no differences between Non‐inf POC and No‐POC patients. POC severity calculated using the Comprehensive Complications Index did not influence OS and DFS before and after PSM. Conclusion The negative oncological impact of POCs after CRLM resection is determined by infective etiology not by severity.

Impact of Postoperative Infectious Complications on Long-Term Outcomes for Patients Undergoing Simultaneous Resection for Colorectal Cancer Liver Metastases: A Propensity Score Matching Analysis

“…The underlying mechanism remains to be fully elucidated, but the clinical utility of our study is still pronounced. POI occurred in 18.8% (90/479) of patients in the present study, and the incidence was consistent with previous studies (28,29) of patients who underwent abdominal surgeries. Because of its controllable and preventable nature, it is of great importance to identify the risk factors.…”

“…Generally, POI not only contributed to longer hospital stays and higher medical costs but was also associated with poor long-term outcomes of patients after surgery for various cancers. Nevertheless, only a few studies have focused on CRLM patients, and previous research is mainly limited to the effect of POI on CRLM patients who receive hepatectomy (28,29). Regardless of the severity (28), POI was proven to be associated with decreased OS and PFS in CRLM patients who underwent hepatectomy.…”

Postoperative complications predict poor outcomes only in patients with a low modified clinical score after resection of colorectal liver metastases: a retrospective cohort study

“…Postoperative complications was categorized as non-infective or infective complications, and the severity of complications was graded using the CCI and Clavien-Dindo classification. Consistent with other analyses in the literature [7,10,11], Clavien-Dindo grade ≤ II and CCI < 26.2 were grouped together. Infective complications included surgicalsite infection, urinary tract infection, respiratory infection, catheter-related bloodstream infection, and systemic sepsis.…”

“…A number of previous studies have shown that postoperative complications can reduce patients' long-term survival and increase the risk of disease recurrence in patients with CRLM [7][8][9][10][11]. However, the postoperative complication criteria to determine survival differ among studies.…”

<p>Associations of Postoperative Complications Assessed by Clavien–Dindo Classification and Comprehensive Complication Index with Long-Term Overall Survival in Elderly Patients after Radical CRC Resection</p>

“…12 In patients undergoing surgery for primary CRC, recent studies have suggested that infectious POCs 13,14 and anastomotic leaks 15 are associated with poor short-term and long-term prognosis. In patients with colorectal liver-metastasis resection, infectious POCs 16,17 have also been observed to be correlated with poor long-term prognosis. As such, it is essential to robustly and reproducibly assess POCs.…”