The impact of postoperative morbidity on survival in patients with metastatic colon and rectal cancer

Abstract

Introduction: Avoiding postoperative morbidity is essential in patients with advanced cancer. To further improve treatment in stage IV colorectal cancer, knowledge about risk factors which effect short‐ and long‐term outcomes is important. Methods: All stage IV colon and rectal cancer who underwent elective surgery between 2004 and 2015 were included (n = 345). We compared resectable colon and rectal patients, and unresectable colon and rectal cancer patients. Results: Median follow‐up duration was 22.2 (unresectable) and 56.7 months (resectable) with no difference in tumor location. Colon cancer patients were more often considered unresectable (P < .001). Rectal procedures were correlated with a higher morbidity rate and a longer surgical duration (P < .001). In the resectable cohort, obese patients, open procedures and prolonged surgery were independently associated with postoperative complications. Considering the palliative group, neoadjuvant treatment and age were correlated with worse outcomes. Morbidity was not associated with long‐term outcomes in the resectable cohort. However, unresectable patients who developed respiratory (hazard ratio [HR]: 7.53) or cardiac (HR: 3.75) complications and patients with an American Society of Anesthesiologists—score III to IV (HR: 1.51) had an impaired survival. Conclusion: Our results emphasize the need for an adequate preoperative assessment to identify patients at risk for postoperative complications and impaired survival.

Recurrence at surgical margin following hepatectomy for colorectal liver metastases is not associated with R1 resection and does not impact survival

“…In addition, our study (Supplementary Table S1) and previous studies have shown the negative impact of postoperative morbidity on long-term survival after hepatetcomy for CRLM. 34,35 Finally, the number of patients included in our study was too small to stratify outcomes according to all sites of extrahepatic recurrence. However, fusion of bicentric data and thorough evaluation of followup imaging by specialized radiologists in each center contributed to precise evaluation of intrahepatic and extrahepatic recurrent disease.…”

Standard and multivisceral colectomy in locally advanced colon cancer

“…According to the literature, MVC is performed in only 1.2-12% of patients with colon cancer. 14,15,21,22 In our study, MVC was performed in 44.8% of patients with LACC, which accounts for 19.2% of a total number of colon resections for cancer. Higher incidence of MVC in our series can be attributed to strict selection criteria in the aforementioned studies, as well as to a significantly higher proportion of late diagnosed patients in our population.…”

Individualized prediction of survival benefit from primary tumor resection for patients with unresectable metastatic colorectal cancer

“…b OS for patients without primary tumor resection method, is preferentially recommended for mCRC patients by various guidelines [6,7], which were proved to be the protective factor in both PTR and non-PTR groups in our study. Although PTR may delay chemotherapy, which could decrease the latter's efficacy [13][14][15][16], PTR could also reduce tumor loading to improve response rates to chemotherapy [27]. Therefore, decision-making should balance the surgery-related benefits and risk.…”

“…A recent meta-analysis of unresectable mCRC patients from 17 retrospective studies by Ha et al revealed significantly improved survival associated with PTR [ 28 ]. Despite the benefits of PTR, it may delay the time in the administration of chemotherapy and increases the potential risk of surgery-related complications, which may subsequently increase death risk [ 13 – 16 ].…”

“…Previous studies suggest that PTR can effectively prevent and reduce the serious tumor-related complications, thereby reducing the risk of death [8][9][10][11][12]. However, some factors which seriously affect survival, such as the delay of chemotherapy and postoperative complications, should also be taken into consideration [13][14][15][16]. So far, mixed conclusions have been reported regarding the PTR procedure [5,[8][9][10][11][12][17][18][19][20][21][22].…”