Impact of complications on long-term survival after resection of colorectal liver metastases
Article first published online: 30 JAN 2013
© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd
British Journal of Surgery
Volume 100, Issue 5, pages 711–718, April 2013
How to Cite
Mavros, M. N., de Jong, M., Dogeas, E., Hyder, O. and Pawlik, T. M. (2013), Impact of complications on long-term survival after resection of colorectal liver metastases. Br J Surg, 100: 711–718. doi: 10.1002/bjs.9060
- Issue published online: 1 MAR 2013
- Article first published online: 30 JAN 2013
- Manuscript Accepted: 29 NOV 2012
Postoperative complications may have an adverse effect not only on short-term but also long-term outcome among patients having surgery for cancer. A retrospective series of patients who had surgery for colorectal liver metastases (CLM) was used to assess this association.
Patients who had surgery with curative intent for CLM from 2000 to 2009 were included. The impact of postoperative complications, patient characteristics, disease stage and treatment on long-term survival was analysed using multivariable Cox regression models.
A total of 251 patients were included. The median age was 58 (interquartile range 51–68) years and there were 87 women (34·7 per cent). A minor or major postoperative complication developed in 41 and 14 patients respectively, and five patients (2·0 per cent) died after surgery. The 5-year recurrence-free (RFS) and overall survival rates were 19·5 and 41·9 per cent respectively. Multivariable analysis revealed that postoperative complications independently predicted shorter RFS (hazard ratio (HR) 2·36, 95 per cent confidence interval 1·56 to 3·58) and overall survival (HR 2·34, 1·46 to 3·74). Other independent predictors of shorter RFS and overall survival included lymph node metastasis, concomitant extrahepatic disease, a serum carcinoembryonic antigen level of at least 100 ng/dl, and the use of radiofrequency ablation (RFS only). The severity of complications also correlated with RFS (P = 0·006) and overall survival (P = 0·001).
Postoperative complications were independently associated with decreased long-term survival after surgery for CLM with curative intent. The prevention and management of postoperative adverse events may be important oncologically.