Impact of postoperative complications on the colorectal cancer survival and recurrence: analyses of pooled individual patients’ data from three large phase III randomized trials

Aoyama, Toru; Oba, Koji; Honda, Michitaka; Sadahiro, Sotaro; Hamada, Chikuma; Mayanagi, Shuhei; Kanda, Mitsuro; Maeda, Hiromichi; Kashiwabara, Kosuke; Sakamoto, Junichi; Saji, Shigetoyo; Yoshikawa, Takaki

doi:10.1002/cam4.1126

Cited by 82 publications

(52 citation statements)

References 20 publications

(19 reference statements)

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“…There was observed, that patients who developed complications during the postoperative period, were exposed to high risk for decease in relation to patients without postoperative complications. Other published reports being similar to our findings (34,35).…”

Section: Resultssupporting

confidence: 94%

Elderly Patients with Colorectal Cancer - A Predisposed Category for Postoperative Complications

Etele¹,

Sala²,

Dénes³

et al. 2019

chr

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Introducere: Cancerul colorectal (CRC) se numără printre principalele cauze de deces cauzate de cancer în întreaga lume. Pacienţii vârstnici sunt adesea consideraţi ca fiind o categorie cu risc crescut, predispuşi la complicaţii postoperatorii. Materiale şi metode: 138 pacienţi cu vârsta de peste 75 de ani şi diagnosticaţi cu cancer colorectal au fost revizuiţi retrospectiv. Pacienţii au fost împărţiţi în două grupuri: Grupul de studiupacienţii care au dezvoltat complicaţii postoperatorii, şi Grupul de control-pacienţii fără probleme în perioada postoperatorie. Au fost comparate date clinice, preoperatorii, chirurgicale, postoperatorii şi oncologice. Scopul studiului a fost de a determina posibili factori de risc în apariţia complicaţiilor postoperatorii şi de a analiza influenţa acestora asupra mortalităţii. Rezultate: Factori de risc cum ar fi sexul bărbătesc, obezitate, insuficienţa cardiacă, diabet zaharat tip II, anemie severă, hipoproteinemie, clasificare ASA III-IV, intervenţiile chirurgicale efectuate în urgenţă, timp operator îndelungat, sângerări semnificative intra-operatorie, internare prelungită, localizare distală a formaţiunilor tumorale, stadiile TNM III-IV, antecedente de cancer digestiv operat sau alte operaţii abdominale majore necanceroase efectuate au fost identificaţi. Concluzii: Tratamentul chirurgical al cancerului colorectal în cazul populaţiei cu vârstă înaintată rămâne o provocare, această categorie de pacienţi trebuie să beneficieze de o atenţie deosebită pentru a asigura o şansă de a minimaliza sau evita aceste complicaţii.

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Section: Resultssupporting

confidence: 94%

Elderly Patients with Colorectal Cancer - A Predisposed Category for Postoperative Complications

Etele¹,

Sala²,

Dénes³

et al. 2019

chr

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“…Major complications after liver resection or at the time of the primary colorectal resection influenced survival after liver resection for CRLM. This is consistent with findings from a study using pooled individual patient data from three large phase III clinical trials of patients who had curative resection of a primary colorectal cancer. The relationship between surgical complications and oncological outcome is not fully understood, but is likely to involve numerous immune regulatory mechanisms and release of inflammatory and growth factors.…”

Section: Discussionsupporting

confidence: 88%

Propensity score analysis of non‐anatomicalversusanatomical resection of colorectal liver metastases

et al. 2019

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Background There are concerns that non‐anatomical resection (NAR) worsens perioperative and oncological outcomes compared with those following anatomical resection (AR) for colorectal liver metastases (CRLM). Most previous studies have been biased by the effect of tumour size. The aim of this study was to compare oncological outcomes after NAR versus AR. Methods This was a retrospective study of consecutive patients who underwent CRLM resection with curative intent from 1999 to 2016. Data were retrieved from a prospectively developed database. Survival and perioperative outcomes for NAR and AR were compared using propensity score analyses. Results Some 358 patients were included in the study. Median follow‐up was 34 (i.q.r. 16–68) months. NAR was associated with significantly less morbidity compared with AR (31·1 versus 44·4 per cent respectively; P = 0·037). Larger (hazard ratio (HR) for lesions 5 cm or greater 1·81, 95 per cent c.i. 1·13 to 2·90; P = 0·035) or multiple (HR 1·48, 1·03 to 2·12; P = 0·035) metastases were associated with poor overall survival (OS). Synchronous (HR 1·33, 1·01 to 1·77; P = 0·045) and multiple (HR 1·51, 1·14 to 2·00; P = 0·004) liver metastases, major complications after liver resection (HR 1·49, 1·05 to 2·11; P = 0·026) or complications after resection of the primary colorectal tumour (HR 1·51, 1·01 to 2·26; P = 0·045) were associated with poor disease‐free survival (DFS). AR was prognostic for poor OS only in tumours smaller than 30 mm, and R1 margin status was not prognostic for either OS or DFS. NAR was associated with a higher rate of salvage resection than AR following intrahepatic recurrence. Conclusions NAR has at least equivalent oncological outcomes to AR while proving to be safer. NAR should therefore be the primary surgical approach to CRLM, especially for lesions smaller than 30 mm.

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“…Surgical resection is the main treatment of choice for patients with stages I-III colorectal cancer [2]. Despite advancements in surgical methods, postoperative complications are observed in up to 35% of patients who undergo radical colorectal cancer surgery [3][4][5][6][7][8]. The impact of postoperative complications that affect long-term oncologic outcomes after radical colorectal surgery is controversial [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Long-term Oncologic Outcome of Postoperative Complications After Colorectal Cancer Surgery

Huh

Lee

et al. 2020

Ann Coloproctol

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Purpose: The impact of postoperative complications on long-term oncologic outcome after radical colorectal cancer surgery is controversial. The aim of this study was to examine the risk factors and oncologic outcomes of surgery-related postoperative complication groups.Methods: From January 2010 to December 2010, 310 patients experienced surgery-related postoperative complications after radical colorectal cancer surgery. These stage I–III patients were classified into 2 subgroups, minor (grades I, II) and major (grades III, IV) complication groups, according to extended Clavien-Dindo classification system criteria. Clinicopathologic differences between the 2 groups were analyzed to identify risk factors for major complications. The diseasefree survival rates of surgery-related postoperative complication groups were also compared.Results: Minor and major complication groups were stratified with 194 patients (62.6%) and 116 patients (37.4%), respectively. The risk factors influencing the major complication group were pathologic N category and operative method. The prognostic factors associated with disease-free survival were preoperative perforation, perineural invasion, tumor budding, and receiving neoadjuvant therapy. With a median follow-up period of 72.2 months, the 5-year disease-free survival rates were 84.4% in the minor group and 78.5% in the major group, but there was no statistical significance between the minor and major groups (P = 0.392).Conclusion: Advanced cancer and open surgery were identified as risk factors for increased surgery-related major complications after radical colorectal cancer surgery. However, severity of postoperative complications did not affect disease-free survival from colorectal cancer.

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Impact of postoperative complications on the colorectal cancer survival and recurrence: analyses of pooled individual patients’ data from three large phase III randomized trials

Cited by 82 publications

References 20 publications

Elderly Patients with Colorectal Cancer - A Predisposed Category for Postoperative Complications

Elderly Patients with Colorectal Cancer - A Predisposed Category for Postoperative Complications

Propensity score analysis of non‐anatomicalversusanatomical resection of colorectal liver metastases

Long-term Oncologic Outcome of Postoperative Complications After Colorectal Cancer Surgery

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