Association Between the Most Frequent Complications After Surgery for Stage I–III Colon Cancer and Short-Term Survival, Long-Term Survival, and Recurrences

• Published in: Annals of surgical oncology Vol. 23; no. 9; pp. 2858 - 2865
• Main Authors: Breugom, A. J., van Dongen, D. T., Bastiaannet, E., Dekker, F. W., van der Geest, L. G. M., Liefers, G. J., Marinelli, A. W. K. S., Mesker, W. E., Portielje, J. E. A., Steup, W. H., Tseng, L. N. L., van de Velde, C. J. H., Dekker, J. W. T.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2016; Springer Nature B.V
• Subjects: Abscess - etiology; Aged; Anastomotic Leak - etiology; Arrhythmias, Cardiac - etiology; Colonic Neoplasms - pathology; Colonic Neoplasms - surgery; Colorectal Cancer; Delirium - etiology; Disease-Free Survival; Female; Gastrointestinal Hemorrhage - etiology; Humans; Ileus - etiology; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Oncology; Pneumonia - etiology; Postoperative Complications - etiology; Proportional Hazards Models; Sepsis - etiology; Surgery; Surgical Oncology; Survival Rate; Time Factors; Urinary Tract Infections - etiology; Water-Electrolyte Imbalance - etiology; Frequent Complication; Specific Complication; Anastomotic Leakage; Postoperative Delirium; Adjusted Hazard Ratio
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5226-z

Background The purpose of this study was to identify the ten most frequent complications after surgery for stage I–III colon cancer and to assess the association between these complications and overall survival, conditional overall survival, and recurrences. Methods All patients who underwent surgery for stage I–III colon cancer in five hospitals in the Western region of the Netherlands were identified. Crude and adjusted Cox proportional hazards models were used to study the association between complications and 1-year overall survival, 5-year overall survival, 5-year conditional overall survival, and 5-year disease-free period. Results Data from 761 patients were used for the analyses. Complications were associated with decreased 1-year overall survival (hazard ratio (HR) 2.87, 95 % confidence interval (CI) 1.82–4.51; p  < 0.001), 5-year overall survival (HR 1.59, 95 % CI 1.25–2.04; p  < 0.001), and 5-year conditional overall survival (HR 1.34, 95 % CI 1.06–1.69; p  = 0.016), whereas an increasing number of complications had no additional impact. Anastomotic leakage, excessive blood loss, and (abdominal) sepsis were associated with reduced 1-year overall survival, anastomotic leakage, delirium, abscess, and (abdominal) sepsis with reduced 5-year overall survival, and anastomotic leakage, delirium, and abscess with reduced 5-year conditional overall survival. Anastomotic leakage, electrolyte disorders, and abscess were risk factors for recurrence within five years. Conclusions Our results demonstrate the serious impact of the most frequent complications after surgery for colon cancer on short-term and long-term outcomes. This study confirms the prolonged impact of surgery and demonstrates that complications result not only in reduced 1-year survival, but also in reduced long-term outcomes.