Abstract
BackgroundThe 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).MethodsThe 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.ResultsIn 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).ConclusionPatients with POCs after colorectal surgery have a poor long-term prognosis. As the CDC grade increases, survival deteriorates.
Highlights
Quality management in colorectal carcinoma is usually divided into short- and long-term results
The aim of the current study was to analyse the impact of postoperative complications on long-term prognosis and to assess the severity of complications graded by the Clavien-Dindo classification (CDC) and their influence on locoregional recurrence, distant metastasis, disease-free survival, and overall survival
We evaluated the prospectively collected database of the Erlangen Registry for Colorectal Carcinomas (ERCRC) according to the following inclusion criteria: solitary invasive colorectal carcinoma; no appendiceal carcinoma; no other previous or synchronous malignancies; carcinomas not related with familial adenomatous polyposis, ulcerative colitis or Crohn’s disease; no distant metastases; radical elective surgery; and residual tumour classification R0
Summary
Quality management in colorectal carcinoma is usually divided into short- and long-term results. How closely these two are linked was first demonstrated with anastomotic leaks. 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). 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. Distant metastasis was highest in CDC III patients (HR 1.7; p = 0.020).
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