title: The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer.
abstract: BACKGROUND
  This study aimed to investigate the impact of postoperative complications on long-term survival and disease recurrence in patients who underwent curative resection for colorectal cancer.
  
  
  METHODS
  Patients who underwent radical resection for colorectal cancer with curative intent from January 1996 to December 2004 were included. Operative mortality and morbidity were documented prospectively. Factors that might affect long-term outcome were analyzed with multivariate analysis.
  
  
  RESULTS
  Curative resection was performed in 1657 patients (943 men), and the median age was 70 years (range: 24-94 years). The 30-day mortality was 2.4%, and the complication rate was 27.3%. Age over 70 years (P < .001, odds ratio: 2.06, 95% CI: 1.63-2.61), male gender (P = .001, odds ratio: 1.49, 95% CI: 1.19-1.88), emergency operation (P < .001, odds ratio: 3.14, 95% CI: 2.26-4.35) and rectal cancer (P < .001, odds ratio: 1.41, 95% CI: 1.25-1.61) were associated with a significantly higher complication rate. With exclusion of patients who died within 30 days, the median follow-up of the surviving patients was 45.3 months. The 5-year overall survival was 64.9%, and the overall recurrence rate was 29.1%. The presence of postoperative complications was an independent factor associated with a worse overall survival (P = .023, hazard ratio: 1.26; 95% CI: 1.03-1.52) and a higher overall recurrence rate (P = .04, hazard ratio: 1.26; 95% CI: 1.01-1.57).
  
  
  CONCLUSIONS
  The presence of postoperative complication not only affects the short-term results of resection of colorectal cancer, but the long-term oncologic outcomes are also adversely affected. Long-term outcomes can be improved with efforts to reduce postoperative complications.
authors.affiliation: Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, China. lawwl@hkucc.hku.hk
authors.forename: Wai Lun
authors.initials: WL
authors.lastname: Law
authors.forename: Hok Kwok
authors.initials: HK
authors.lastname: Choi
authors.forename: Yee Man
authors.initials: YM
authors.lastname: Lee
authors.forename: Judy Wc
authors.initials: JW
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome