Impact of Postoperative Infectious Complications on Long-Term Outcomes for Patients Undergoing Simultaneous Resection for Colorectal Cancer Liver Metastases: A Propensity Score Matching Analysis

Abstract

ObjectiveTo investigate the impact of postoperative infectious complications (POI) on the long-term outcomes of patients with colorectal cancer liver metastasis (CRLM) after simultaneous resection of colorectal cancer and liver metastases.MethodsFour hundred seventy-nine CRLM patients receiving simultaneous resection between February 2010 and February 2018 at our hospital were enrolled. A 1:3 propensity score matching analysis (PSM) analysis was performed to balance covariates and avoid selection bias. After PSM, 90 patients were distributed to the POI group, and 233 patients were distributed to the no POI group. A log-rank test was performed to compare the progression-free survival (PFS) and overall survival (OS) data. A multivariate Cox regression model was employed to identify prognostic factors influencing OS and PFS. A value of two-sided P<0.05 was considered statistically significant.ResultsCompared to patients in the no POI group, patients in the POI group were more likely to have hepatic portal occlusion (78.9% vs. 66.3%, P=0.021), operation time ≥325 min (61.1% vs. 48.1%, P=0.026), and intraoperative blood loss ≥200 ml (81.1% vs. 67.6%, P=0.012). In multivariate analysis, intraoperative blood loss ≥200 ml (OR = 2.057, 95% CI: 1.165-3.634, P=0.013) was identified as the only independent risk factor for POI. Patients with POI had a worse PFS (P<0.001, median PFS: 7.5 vs. 12.7 months) and a worse OS (P=0.010, median OS: 38.8 vs. 59.0 months) than those without POI. After 1:3 PSM analysis, no differences in clinicopathologic parameters were detected between the POI group and the no POI group. Patients with POI had a worse PFS (P=0.013, median PFS: 7.5 vs. 11.1 months) and a worse OS (P=0.020, median OS: 38.8 vs. 59.0 months) than those without POI. Multivariate analysis showed that POI was an independent predictor for worse PFS (HR=1.410, 95% CI: 1.065-1.869, P=0.017) and worse OS (HR=1.682, 95% CI: 1.113-2.544, P=0.014).ConclusionsPOI can significantly worsen the long-term outcomes of CRLM patients receiving simultaneous resection of colorectal cancer and liver metastases and should be considered to improve postoperative management and make better treatment decisions for these patients.

Postoperative infectious complications worsen oncologic outcomes following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

“…Infectious complications (IC) are among the most common adverse outcomes following PD. Additionally, evidence suggests that postoperative IC can affect oncologic outcomes for patients undergoing surgery for malignant disease 15 …”

“…Additionally, evidence suggests that postoperative IC can affect oncologic outcomes for patients undergoing surgery for malignant disease. 15 Currently, there are limited data regarding the influence of postoperative IC on patients undergoing surgery for malignant pancreatic diseases, particularly when such complications occur without clinically relevant postoperative pancreatic fistula (CR-POF). Consequently, this study aims to evaluate the effect of non-CR-POF-related postoperative IC on the OS of patients who have undergone PD for PDAC at a high-volume pancreatic center.…”

Effect of the systemic immune-inflammation index on postoperative complications and the long-term prognosis of patients with colorectal cancer: a retrospective cohort study

“…Similarly, a foreign study showed that the incidence of postoperative infectious complications in patients with CRC was as high as 16.59% (4). Postoperative complications can lead to increased recurrence and mortality; moreover, Chen et al showed that in patients with CRC liver metastases, postoperative infectious complications were associated with worse progression-free survival (PFS) and overall survival (5).…”

The Impact of Postoperative Complications on Survival after Simultaneous Resection of Colorectal Cancer and Liver Metastases

“…A major concern regarding SR is the higher incidence of postoperative complications and their potential impact on long-term outcomes, and this has led to reluctance to perform SR [ 13 , 14 ]. Despite the attractiveness of the concept of the simultaneous excision of colon cancer and liver metastases, there is still a paucity of high-quality evidence.…”