Influence of Anastomotic Leak After Elective Colorectal Cancer Resection on Survival and Local Recurrence: A Propensity Score Analysis

Zimmermann, Markus; Wellner, Ulrich F.; Laubert, Tilman; Ellebrecht, David Benjamin; Bruch, Hans–Peter; Keck, Tobias; Schlöricke, Erik; Benecke, Claudia

doi:10.1097/dcr.0000000000001287

Cited by 34 publications

(27 citation statements)

References 19 publications

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“…In the current study, preoperative serum levels of CEA and CA19-9 and the incidence of anastomotic leakage were independently associated with worse RFS or OS following surgery for stage II colorectal cancer; consistent with the findings of previous studies (49)(50)(51). Identifying predictive biomarkers for the selection of patients with stage II colorectal cancer who could benefit from adjuvant chemotherapy are important.…”

Section: Discussionsupporting

confidence: 90%

Advanced Age Is a Risk Factor for Recurrence After Resection in Stage II Colorectal Cancer

Mima

Kurashige

Miyanari

et al. 2019

In Vivo

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Background/Aim: The number of older patients with colorectal cancer (CRC) is increasing. Stage II CRC is a heterogeneous group of cancers with different prognoses. We aimed to examine older patients in relation to clinical outcome following curative resection in stage II CRC. Patients and Methods: We analyzed data for 329 consecutive patients with stage II CRC following curative resection. Recurrence-free survival (RFS) and overall survival (OS) were compared between older patients ≥75 years of age and those <75 years. Cox proportional hazards model was used to compute hazard ratios (HRs) controlling for potential confounders. Results: In the multivariable analyses, patients ≥75 years were independently associated with shorter RFS (multivariable HR=2.56, 95% confidence interval (CI)=1.55-4.31, p<0.001) and OS (multivariable HR=4.36, 95%CI=2.08-9.97, p<0.001) in stage II CRC. Conclusion: Older patients were independently associated with shorter RFS and OS following curative resection in stage II CRC. Colorectal cancer is the most common cancer in Japan and the third most common cancer worldwide (1, 2). Surgery with complete resection represents a potentially curative treatment for most patients with stage I or II colorectal cancer (3, 4). Although the current standard treatment for stage III colorectal cancer is curative surgery and adjuvant chemotherapy, the benefit of adjuvant chemotherapy in patients with stage II colorectal cancer remains controversial (5). Stage II colorectal cancer is a heterogeneous group of cancers with differing biology (6). Large-scale studies demonstrate that patients with stage II colorectal cancer have widely different prognoses (7-9). Western clinical guidelines indicate: i) T4 stage, ii) fewer than 12 examined lymph nodes, iii) bowel perforation and obstruction, iv) lymphatic and venous invasion, and v) poorly differentiated tumors as poor prognostic factors in stage II colorectal cancer and recommend adjuvant chemotherapy for patients presenting these 'highrisk' features (10, 11). Unfortunately, the benefit of adjuvant chemotherapy for such patients has not been confirmed yet (5, 12). Hence, identifying predictive biomarkers for the selection of patients with stage II colorectal cancer who benefit from adjuvant chemotherapy are important. Due to low birth and high longevity rates many populations around the world are aging rapidly, resulting in an increasing requirement for surgery to treat gastrointestinal cancer in older patients (13-16). Because many clinical trials for colorectal cancer have not included patients with colorectal cancer ≥75 years of age (17-19), there is a lack of evidence-based guidelines for older patients with colorectal cancer, who usually have age-related compromised organ function and host immunity (20, 21). Here we tested the hypothesis that older patients may suffer worse clinical outcomes following curative resection in stage II colorectal cancer. Patients and Methods Patients. We retrospectively analyzed data for consecutive patients with pathological ...

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Section: Discussionsupporting

confidence: 90%

Advanced Age Is a Risk Factor for Recurrence After Resection in Stage II Colorectal Cancer

Mima

Kurashige

Miyanari

et al. 2019

In Vivo

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“…A limitation of the algorithm used to assess recurrence is that it cannot distinguish between local recurrence and distant metastasis. However, the findings of our study are supported by a recent match‐paired analysis that found no difference in overall survival, DFS or local recurrence [29].…”

Section: Discussionsupporting

confidence: 86%

The impact of postoperative complications and delay of adjuvant chemotherapy on oncological outcomes in patients with colorectal cancer

Fransgaard

Thygesen

Gögenür³

2021

Colorectal Disease

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Aim Postoperative complications are believed to result in poorer long‐term oncological outcomes. The contribution of time to chemotherapy has not been analysed in detail. Our aim was to examine the association between postoperative complications and long‐term oncological outcomes and overall survival, and the influence of delay in chemotherapy on these outcomes. Method The study was a nationwide register‐based observational study that included patients undergoing surgery for colorectal cancer and receiving adjuvant chemotherapy in Denmark between 2010 and 2015. Information regarding postoperative complications was obtained from the Danish Colorectal Cancer Group national clinical registry. A Cox regression model was used to estimate disease‐free survival, recurrence‐free survival and all‐cause mortality in patients surviving for 180 days or more after surgery. Results A total of 4083 patients were included, of whom 690 had postoperative complications. Postoperative complications were associated with increased odds of delay to adjuvant chemotherapy (odds ratio 4.56, 95% CI 3.67–5.66, p < 0.0001). An unadjusted analysis revealed that patients with complications had poorer disease‐free survival and recurrence‐free survival and had increased all‐cause mortality. In multivariate analysis, postoperative complications were not associated with poorer disease‐free survival [hazard ratio (HR) 1.02, 95% CI 0.88–1.18, p = 0.80] recurrence‐free survival (HR 1.05, 95% CI 0.89–1.25, p = 0.56) or all‐cause mortality (HR 1.04, 95% CI 0.86–1.26, p = 0.67). Conclusion This study showed no association between the occurrence of postoperative complications and long‐term prognosis when adjusting for time to adjuvant chemotherapy.

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“…Finally, a low SAS was associated with POCs. POCs affect the prognosis in CRC because of marked postoperative in ammation and a poor immunological status [21,22]. In the present study, a lower SAS was signi cantly associated with severe POCs.…”

Section: Discussionsupporting

confidence: 50%

The Impact of the Surgical Apgar Score On Oncological Outcomes in Patients With Colorectal Cancer: A Single-Center Retrospective Cohort Study

Sugimoto

Fukuoka

Nagahara

et al. 2021

Preprint

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Background: The surgical Apgar score (SAS) predicts postoperative complications (POCs) following gastrointestinal cancer surgery. Recently, the SAS was reported to be a predictor of not only POCs but also the prognosis. However, the impact of the SAS on oncological outcomes in patients with colorectal cancer (CRC) has not been fully examined. The present study therefore explored the oncological significance of the SAS in patients with CRC.Methods: We retrospectively analyzed 639 patients who underwent radical surgery for CRC. The SAS was calculated based on three intraoperative parameters: estimated blood loss, lowest mean arterial pressure and lowest heart rate. The optimal cut-off value of the SAS was determined by receiver operating characteristic curves. All patients were classified into 2 groups based on the SAS (≤6 and >6). The association of the SAS with the recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) was analyzed.Results: Univariate analyses revealed that a lower SAS (≤6) was significantly associated with a worse RFS, OS and CSS. A multivariate analysis revealed that age ≥75 years old, Charlson comorbidity index ≥1, ASA-Physical Status ≥3, SAS ≤6, histologically undifferentiated tumor type and an advanced pStage were independent factors for the OS, and an SAS ≤6 and advanced pStage were independent factors for the CSS.Conclusions: A lower SAS (≤6) was an independent prognostic factor for not only the OS but also the CSS in patients with CRC, suggesting that the SAS might be a useful biomarker predicting oncological outcomes in patients with CRC.

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Influence of Anastomotic Leak After Elective Colorectal Cancer Resection on Survival and Local Recurrence: A Propensity Score Analysis

Cited by 34 publications

References 19 publications

Advanced Age Is a Risk Factor for Recurrence After Resection in Stage II Colorectal Cancer

Advanced Age Is a Risk Factor for Recurrence After Resection in Stage II Colorectal Cancer

The impact of postoperative complications and delay of adjuvant chemotherapy on oncological outcomes in patients with colorectal cancer

The Impact of the Surgical Apgar Score On Oncological Outcomes in Patients With Colorectal Cancer: A Single-Center Retrospective Cohort Study

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