Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;35(6):1055-1066.
doi: 10.1007/s00384-020-03557-3. Epub 2020 Mar 14.

The influence of postoperative complications on long-term prognosis in patients with colorectal carcinoma

Clemens Beck  1 , Klaus Weber  1 , Maximilian Brunner  1 , Abbas Agaimy  2 , Sabine Semrau  3 , Robert Grützmann  1 , Vera Schellerer  1 , Susanne Merkel  4
Affiliations

The influence of postoperative complications on long-term prognosis in patients with colorectal carcinoma

Clemens Beck et al. Int J Colorectal Dis. 2020 Jun.

Abstract

Background: The impact of postoperative complications (POCs) on the long-term prognosis of patients with colorectal carcinoma was analysed with respect to their severity according to the Clavien-Dindo classification (CDC).

Methods: The prospectively collected data of 2158 patients who underwent curative resection of a colorectal carcinoma (1168 rectal carcinomas, 990 colon carcinomas) without distant metastases from 1995 to 2014 were analysed. The POCs were documented in a standardized form and graded with the CDC. Patients who died postoperatively (CDC grade V, 1.7%) were excluded.

Results: In total, 467 patients (21.6%) had POCs: CDC I, 141 (6.5%); CDC II, 162 (7.5%); CDC III, 112 (5.2%); and CDC IV, 52 (2.4%). More POCs and higher CDC grades were found in men, ASA III-IV patients, rectal carcinoma patients, and patients who underwent abdominoperineal excisions or multivisceral resections. The 5-year locoregional recurrence rate was 5.3% in patients without POCs and 6.6% in patients with POCs. It was highest in CDC III patients (12.9%), which was confirmed in multivariate analysis (HR 2.2; p = 0.005). The 5-year distant metastasis rate was 15.9% in CDC 0 patients and 19.5% in CDC I-IV patients. In multivariate analysis, distant metastasis was highest in CDC III patients (HR 1.7; p = 0.020). The 5-year overall survival rate was 83.5% in patients without POCs and 73.5% in patients with POCs. It was worst in CDC IV patients (63.1%), which was confirmed by multivariate analysis (HR 1.9; p = 0.001).

Conclusion: Patients with POCs after colorectal surgery have a poor long-term prognosis. As the CDC grade increases, survival deteriorates.

Keywords: Clavien-Dindo classification; Colorectal carcinoma; Postoperative complications; Prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves of the time to locoregional recurrence (n = 2158)
Fig. 2
Fig. 2
Kaplan-Meier curves of the time to distant metastases (n = 2158)
Fig. 3
Fig. 3
Kaplan-Meier curves of disease-free survival (n = 2158)
Fig. 4
Fig. 4
Kaplan-Meier curves of overall survival (n = 2158)
See this image and copyright information in PMC

References

    1. Akyol AM, McGregor JR, Galloway DJ, Murray GD, George WD. Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Color Dis. 1991;6(4):179–183. doi: 10.1007/BF00341385. - DOI - PubMed
    1. Merkel S, Wang WY, Schmidt O, Dworak O, Wittekind C, Hohenberger W, Hermanek P. Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma. Color Disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2001;3(3):154–160. doi: 10.1046/j.1463-1318.2001.00232.x. - DOI - PubMed
    1. Wang S, Liu J, Zhao H, Ge S, Wang W. Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg. 2017;41(1):277–284. doi: 10.1007/s00268-016-3761-1. - DOI - PMC - PubMed
    1. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518–526. - PubMed
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. doi: 10.1097/01.sla.0000133083.54934.ae. - DOI - PMC - PubMed

MeSH terms