Liver disease and 30-day mortality after colorectal cancer surgery: a Danish population-based cohort study

Abstract

BackgroundColorectal cancer (CRC) is common, with surgery as the main curative treatment. The prevalence of chronic liver disease has increased, but knowledge is limited on postoperative mortality in patients with liver disease who undergo CRC surgery. Hence, we examined 30-day mortality after CRC surgery in patients with liver disease compared to those without liver disease.MethodsWe used medical databases to conduct a nationwide cohort study of all patients undergoing CRC surgery in Denmark from 1996 through 2009. We further identified patients diagnosed with any liver disease before CRC surgery and categorized them into two cohorts: patients with non-cirrhotic liver disease and patients with liver cirrhosis. Patients without liver disease were defined as the comparison cohort. Using the Kaplan-Meier method, we computed 30-day mortality after CRC surgery in each cohort. We used a Cox regression model to compute hazard ratios as measures of the relative risk (RR) of death, controlling for potential confounders including comorbidities. In order to examine the impact of liver disease in different subgroups, we stratified patients by gender, age, cancer stage, cancer site, timing of admission, type of surgery, comorbidity level, and non-hepatic alcohol-related disease.ResultsOverall, 39,840 patients underwent CRC surgery: 369 (0.9%) had non-cirrhotic liver disease and 158 (0.4%) had liver cirrhosis. Thirty-day mortality after CRC surgery was 8.7% in patients without liver disease and 13.3% in patients with non-cirrhotic liver disease (adjusted RR of 1.49 95% confidence interval (CI): 1.12-1.98). Among patients with liver cirrhosis, mortality was 24.1%, corresponding to an adjusted RR of 2.59 (95% CI: 1.86-3.61). The negative impact of liver disease on postoperative mortality was found in all subgroups.ConclusionsPre-existing liver disease was associated with a markedly increased 30-day mortality following CRC surgery.

Management of colon cancer in patients with cirrhosis: A review

“…In a Danish populationbased cohort study, Montomoli et al studied risk factors for 30-day mortality after colorectal surgery for cancer. The researchers found that laparoscopic radical resection was associated with a 6.82-fold greater risk of mortality, whereas open radical resection was associated with a 3.01-fold greater risk of mortality; this finding suggests that laparoscopic resection may be associated with a higher risk of mortality than open resection, even though a direct comparison has not been performed [23].…”

“…In a Danish population-based cohort study on colorectal surgery, Montomoli et al studied risk factors for 30-day mortality. The researchers found that cirrhotic patients had a 2.59-fold greater risk of 30-day mortality than the general population, with a 2.5-fold greater risk after colon cancer surgery and 2.84-fold greater risk after rectal cancer surgery [23]. In a series of 10033 patients, MELD was an independent predictor of mortality after colorectal surgery (odds ratio: 2.95; 95%CI: 2.27e3.84) [29].…”

Perioperative Risk Assessment and Management of Cirrhotic Patients

“…2013 study: Overall colorectal surgery mortality was 8.7% (non-liver disease) vs. 13.3% (non-cirrhotics), and 24.1% (cirrhotics) [203].…”

“…The 2013 Danish 30-day study included 29,840 surgeries, sub-group analysis resulted with a higher mortality in surgery of the colon versus rectal, with 9, 14, and 27% vs. 6, 10, and 19% mortality of non-liver disease, non-cirrhotics, and LC, respectively [203].…”

Operationsrisiko bei chronischen Lebererkrankungen

“…Patienten mit schweren Lebererkrankungen weisen im Vergleich zu Patienten ohne Leberprobleme ein erhöhtes Morbiditäts-und Mortalitätsrisiko bei chirurgischen Eingriffen auf [1][2][3].…”