&lt;p&gt;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&lt;/p&gt;

Wang, Dong; Zhang, Jinghui; Bai, Zhigang; Yang, Yingchi; Wang, Tingting; Jin, Lan; Wang, Jin; Wu, Guang; Kou, Tiankuo; Zhang, Zhongtao

doi:10.2147/cia.s271969

Cited by 17 publications

(13 citation statements)

References 36 publications

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“…Studies have shown that POCs can reduce the long-term survival outcome of colorectal cancer [16][17][18]; the same trend has also been observed in gastric cancer [9,19,20].…”

Section: Discussionsupporting

confidence: 52%

Effects of Clavien-Dindo classification on long-term survival of patients with advanced gastric cancer after radical resection:A propensity score-matched study

Yan

Qing-yi

et al. 2021

Preprint

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Background The impact of postoperative complications (POCs) classified by the Clavien-Dindo (C-D) system on long-term survival after radical resection in patients with advanced gastric cancer (AGC) is not yet clear.Methods This study analyzed 531 patients with AGC who underwent radical resection in an institution between January 2015 and December 2017. Patients were divided into two groups according to the occurrence of POCs and recorded according to C-D classifications.The long-term survival outcomes of the entire cohort after propensity score matching (PSM) were compared.Results After PSM, there was no significant difference in baseline data between the complications (C) group (n = 92) and the non-complications (NC) group (n = 92). Survival analysis showed that the 5-year overall survival (OS) and relapse-free survival (RFS) were lower in the C group (48.9% vs. 62.0%, p = 0.040; 38.5% vs. 54.9%, p = 0.005; respectively). Subgroup analysis showed that severe complications (C-D grade > II) were associated with a decrease in 5-year OS and RFS compared with the matched NC group (40.0% vs. 62.0%, p = 0.008; 29.4% vs. 54.9%, p = 0.001; respectively). Multivariate analysis confirmed adjuvant chemotherapy, tumor size, and complications were independent risk factors for poor survival outcomes. Further multivariate analysis showed that older age, combined excision, and comorbidities were independent risk factors for POCs.Conclusions Severe complications reduced the survival outcome of patients.Older age, combined excision, and comorbidities were independent risk factors for POCs. More attention should be paid to perioperative management of patients with high risk factors for complications.

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“…Studies have shown that POCs can reduce the long-term survival outcome of colorectal cancer [16][17][18]; the same trend has also been observed in gastric cancer [9,19,20].…”

Section: Discussionsupporting

confidence: 52%

Effects of Clavien-Dindo classification on long-term survival of patients with advanced gastric cancer after radical resection:A propensity score-matched study

Yan

Qing-yi

et al. 2021

Preprint

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“…Moreover, there is growing evidence that postoperative complications not only have a direct impact on short-term outcomes but also impact systemic inflammatory response, which may adversely affect the oncological outcome [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery

Tamini

Bernasconi

Ripamonti

et al. 2021

Cancers

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(1) Introduction: To date, the sensitivity of the Comprehensive Complication Index (CCI) in a homogeneous cohort of colonic resections for oncologic purposes has not been reported. The present study aims to compare the CCI with the conventional Clavien–Dindo classification (CDC) in colon cancer patients. (2) Methods: The clinical data of patients submitted to an elective colectomy for adenocarcinoma were retrieved from a prospectively maintained database. Postoperative complications and length of stay were reviewed, and CDC and CCI scores were calculated for each patient. The association of the CCI and the CDC with the length of stay, prolongation of stay and readmission rate were assessed and compared. (3) Results: The overall postoperative morbidity was 26.9%. In particular, 157 (20.4%) patients had more than one complication. A strong correlation between the two scoring systems was observed (r = 99.4%; 95%CI: 99.3–99.5%). In multivariate analysis, CCI had a higher predictive ability for all endpoints. Regarding subgroup analysis, the difference between the CCI and CDC was progressively increased when evaluating outcome measures in complicated and multi-complicated patients. (4) Conclusion: Both scoring systems adequately report the overall burden of postoperative complications. The CCI showed a greater ability than the CDC to predict hospital stay, particularly in patients with multiple postoperative complications.

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“…The JCOG0404 study (20) did not prove the non-inferiority of laparoscopy to open surgery, but it did show a decrease in complications, length of hospital stay, and blood loss. There is a report that less postoperative complications affect the difference in survival rate (21), and in this study, age and postoperative complications may have affected the survival rate. HALS may be a surgical technique that incorporates the advantages of both CL and LAP, and although a comparative study of the three surgical techniques is needed in the future, HALS is considered to be useful for patients over 80 years old.…”

Section: Discussionmentioning

confidence: 61%

Efficacy of hand-assisted laparoscopic surgery (HALS) in older adult patients (≥80 years) with primary colorectal cancer

Koike

Mukai

Abe

et al. 2022

J Gastrointest Oncol

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Background: From 2004 to 2014, 821 colorectal cancer primary resections were conducted at our institution. Of these, 102 patients (12.4%) were older adults over 80 years old. underwent either the conventional laparotomy group (72 patients) or the hand-assisted laparoscopic surgery (HALS) group (30 patients).Methods: Data were extracted for 102 patients over 80 years old who underwent primary resection for colorectal cancer and were divided into two groups: conventional laparotomy (CL) (n=72) and hand-assisted laparoscopy (n=30). Pre-operative characteristics and outcomes were compared.Results: Baseline characteristics were similar between groups, except for age: CL group median 83.5 years old (range, 80-92 years old) and hand-assisted laparoscopy (HALS) group median 81.5 years old (range, 80-88 years old) (P=0.027). Pre-operative cardiac and lung function risk, performance status, and pathological classification stage (pStage) were almost similar between groups (P=0.668, P=0.176, P>0.999, P=0.217). No significant differences were found for operation time. The HALS group resulted in less blood loss (median 204 mL in the CL group and median 68 mL in the HALS group, P=0.003), shorter postoperative hospital stay (median was 18 days in the CL group and median was 12 days in the HALS group, P<0.001), and fewer postoperative wound infections (18 cases in the CL group and 2 cases in the HALS group, P=0.034). Five-year relapse-free survival (5Y-RFS) was 48.1% in the CL group and 73.3% in the HALS group (P=0.028). Five-year overall survival (5Y-OS) was 48.2% in the CL group and 73.3% in the HALS group (P=0.027).Conclusions: Approximately 70% of surgical treatment for patients over 80 years old with colorectal carcinoma were performed by CL. However, HALS had significant advantages including less blood loss, fewer wound infections, and shorter hospital stays. Therefore, HALS could proactively be considered to older adult patients with colorectal cancer.

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<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>

Cited by 17 publications

References 36 publications

Effects of Clavien-Dindo classification on long-term survival of patients with advanced gastric cancer after radical resection:A propensity score-matched study

Effects of Clavien-Dindo classification on long-term survival of patients with advanced gastric cancer after radical resection:A propensity score-matched study

Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery

Efficacy of hand-assisted laparoscopic surgery (HALS) in older adult patients (≥80 years) with primary colorectal cancer

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