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

Abstract

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.

Postoperative liver dysfunction is associated with poor long-term outcomes in patients with colorectal cancer: a retrospective cohort study

“…However, there was no significant difference in the frequency of liver metastasis recurrence between patients with or without postoperative liver dysfunction. Postoperative complications are significantly associated with worse rates and delays in adjuvant chemotherapy [ 14 , 15 ]. However, in this study, the induction rate of postoperative adjuvant chemotherapy did not differ between patients with or without postoperative liver dysfunction (Supplementary Table 4 ).…”

Improved Survival After Adjuvant Therapy in Locally Advanced Rectal Cancer Patients With Pathologic Complete Response

“…Although not recorded in the NCDB, patients with a postoperative complication are also significantly less likely to receive adjuvant therapy. 12–14 In this study, elderly patients (>70 y) were significantly less likely to receive adjuvant chemotherapy. Adjuvant chemotherapy in the elderly has not consistently demonstrated improved DFS or OS and is associated with increased treatment-related toxicities, 15 which may explain the hesitancy in prescribing additional chemotherapy in older patient populations.…”

Influence of Primary Tumor Resection on Survival of Patients With Metastatic Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Population-Based, Propensity-Matched Analysis

“…Both endoscopic resection and surgery might delay the performance of systemic treatment, especially in the case of severe post-operative complications. 25 Although surgical resection is the only curative intervention in most types of malignancies, existing studies suggest that surgery might be associated with tumor progression. 26 For one thing, surgical resection potentially enhances metastatic seeding of tumor cells and increases the formation of new metastatic niche.…”