Impact of Postoperative Complications on Survival and Recurrence After Resection of Colorectal Liver Metastases

Abstract

Objective: To study the effect of postoperative complications (POC) on overall survival (OS) and disease-free survival (DFS) after surgical resection of colorectal liver metastases (CRLM). Summary Background Data: Morbidity rates after liver resection can reach 45%. The negative impact of POC on oncologic outcomes has been reported in various types of cancer, especially colorectal. However, data on the consequences of POC after CRLM resection on long-term survival are scarce. Methods: Eligible studies examining the association between POC after CRLM resection and OS/DFS were sought using the PubMed and Web of Science databases. A random-effects model was used to calculate pooled effect estimate for OS and DFS hazard ratios (HR), estimating between-study variance with restricted maximum likelihood estimator with Hartung–Knapp adjustment. Subgroup analysis was used to control the effect of POC on OS and DFS for: 1) Method used to define postoperative complications, 2) Exclusion of early postoperative death from survival analysis, 3) Method of data extraction used, and 4) Tumor and treatment characteristics. Results: Forty-one studies were deemed eligible, including 12,817 patients. POC patients had a significant risk of reduced OS compared with no POC group (HR 1.43 [95% CI: 1.3, 1.57], P < 0.0001). POC had also a negative impact on DFS. The HR for reduced DFS was 1.38 [95% CI 1.27, 1.49], P < 0.0001. The negative impact of POC on survival and recurrence was confirmed in subgroup analysis. Conclusions: Our findings evidence the negative impact of POC on survival and recurrence after CRLM resection.

Impact of type and severity of postoperative complications on long‐term outcomes after colorectal liver metastases resection

“…Furthermore, after including adjuvant treatment administration in the propensity score analysis as a possible confounding factor, infective POC maintained their negative impact on OS and DFS. These findings confirm the results shown in the meta‐analysis recently published 8 which verified the negative impact of POC on oncologic results after CRLM resection in a subgroup analysis taking into account adjuvant treatment administration. It is known that conventional chemotherapy alters immune cell function as well as its direct cytocidal effects on proliferating tumor cells 29 .…”

“…The negative impact of POC on oncologic outcomes after CRLM resection has been put under the spotlight by a recently published meta‐analysis and several retrospective series 6‐8 . Previously, our group showed that patients with POC have 43% and 38% more probabilities of death and recurrence, respectively than uncomplicated patients after reviewing 41 studies including more than 12000 patients 8 . Some recent publications focused their attention on the severity and the etiology of POC, to try to better understand the mechanism on the base of their negative oncological impact.…”

“…We believe this study can help to better understand the long‐term effect of POC on patients with CRLM. On the basis of the current evidence, 6‐8,34,35 future clinical risk scores of recurrence after CRLM 32,33,36 should consider the inclusion of POC as a risk factor for decreased OS and DFS. Furthermore, in our opinion, POC should always be reported using a validated score such as the Dindo‐Clavien or the CCI and should be categorized in infective, noninfective, systemic, or local to better understand the effect of different types of POC on oncologic outcomes.…”

“…The impact of POC on long‐term survival of patients undergoing liver resection for colorectal liver metastases (CRLM) has also been suggested 5 . Decreased OS and DFS in patients with POC after hepatectomies for CRLM have been described by retrospective series 6,7 and a recently published meta‐analysis 8 …”

Mu Opioid Receptor 1 (MOR-1) Expression in Colorectal Cancer and Oncological Long-Term Outcomes: A Five-Year Retrospective Longitudinal Cohort Study

“…We hypothesized that MOR-1 expression is increased in colorectal cancer (versus non-tumor adjacent tissue) and is associated with shorter disease-free survival. We also evaluated the association between MOR-1 expression with overall survival and postoperative complications as well, since the latter have been associated with poor oncological outcomes [23] and can be associated with opioid usage.…”