The Determinants of Long-Term Outcomes After Colorectal Cancer Surgery: A Literature Review

Abstract

Colorectal cancer (CRC) is a common malignancy associated with high mortality. Surgical care is an effective colorectal cancer management technique, and it is therefore crucial that a review of the determinants of patients' long-term outcomes after CRC surgery is conducted. This article aims to provide healthcare professionals and policymakers with insights into the determinants of long-term outcomes following CRC surgery while acknowledging the interconnected impact of the early recovery and post-operative periods. For this review, PubMed and Google Scholar were used to search for literature on the determinants of long-term outcomes of patients post-colorectal cancer surgery. The determinants included pre-operative factors, CRC surgery factors (anatomical location of the lesion, select operative techniques, and cancer disease stage), adherence to the Enhanced Recovery After Surgery (ERAS) guidelines, post-operative complications, presence of an ostomy, physical activity levels, psychosocial factors, recurrence, and follow-up strategies. Selection criteria were published articles between 1994 and 2024 on colorectal cancer, its surgery, and determinants of outcomes. Several key determinants influence long-term outcomes following colorectal cancer surgery, including preoperative factors, CRC surgery factors, adherence to the ERAS guidelines, postoperative complications, the presence of an ostomy, physical activity levels, psychosocial factors, recurrence, and follow-up strategies. These determinants collectively impact survival, quality of life, functional recovery, and psychosocial well-being. On the one hand, negative outcomes following colorectal cancer surgery are often linked to preoperative factors such as poor nutritional status, sarcopenia, and inadequate adherence to ERAS guidelines during the perioperative period. Minimally invasive surgeries, while as effective as open surgeries for early-stage CRC, may be less suitable for advanced stages and often involve prolonged operating times - a factor linked to poorer outcomes. Complications of CRC surgery, such as anastomotic leakage, chronic surgical site pain, bowel dysfunction, and urological issues, further contribute to negative long-term outcomes. High recurrence rates are also linked to poor prognoses, emphasizing the importance of regular surveillance and timely interventions, though these can lead to patient anxiety and overtreatment. The presence of an ostomy can impact psychosocial adjustment and overall quality of life, further influencing long-term outcomes. On the other hand, positive outcomes are associated with regular physical activity post-surgery, which significantly aids long-term recovery irrespective of preoperative activity levels. Psychosocial support networks also play a crucial role in mitigating mental health challenges often faced after CRC surgery. Collectively, these determinants underscore the complexity of long-term outcomes in colorectal cancer surgery and highlight the importance of a holistic approach to patient care.

Keywords: colorectal cancer surgery; long term outcomes; post-operative outcomes; quality of life; recurrence rates.

Figure 1. Patient's perceived predictors of optimal quality of life after colorectal cancer surgery

Original work of authors. A study highlighting the importance of avoiding a stoma to patients as the most important factor after CRC surgery over being cured of primary pathology, post-operative complications, and other surgical factors.

Figure 2. Anxiety, depression, and post-traumatic stress disorder rise steeply after colorectal cancer surgery

Original work of authors. The level of Anxiety, depression, and PTSD in the average population is 5.9%, 3.3%, and 4.4%, respectively. These levels rise to 20%, 22%, and 14%, respectively after CRC surgery.