title: [Effect of postoperative complications on late recurrence and distant metastasis in patients previously treated with elective, curative resection of colorectal carcinoma].
abstract: BACKGROUND
  The aim of the present study is to investigate whether severe postoperative complications following elective colorectal surgery increase local recurrence or distant metastasis rate.
  
  
  METHODS
  332 patients underwent elective, curative colorectal carcinoma resection in the period between 01.01.2000 and 31.12.2004. Postoperative complications were classified according to the modified Clavien Scale. Complications occurring up to postoperative day 30 were recorded. All complications were analyzed but the most severe one was considered for each patient and included in further analysis. Patients were followed up until 31.12.2009. Univariate and multivariate statistical analyses were performed.
  
  
  RESULTS
  The mean age of patients was 64 years, 187 (56%) were male. 84 patients (25.3%) received preoperative oncological treatment. We included patients only with R0 resections. 182 patients (56.3%) recovered after the surgery without any complications. Mortality rate was 3.3%. Grade 4 complication developed in 5 (1.5%) patients, while Grade 3 in 26 (8%) patients, Grade 2 in 83 (25.8%) patients, and Grade 1 in 25 (7.7%) patients. During the follow up period 75 (23.3%) patients developed local tumor recurrence and/or distant metastasis. Tumor grade (p = 0.008), stage (p = 0.0001) and histological lympho-vascular invasion of the tumor (p = 0.0001) were associated with increased local and distant tumor recurrence rates. Further, Grade 3 postoperative complications were associated with increased tumor recurrence rate (p = 0.0039) and tumor related mortality (p = 0.05%).
  
  
  CONCLUSIONS
  application of the modified Clavien Scale is suitable to classify the severity of postoperative complications. Grade 3 complications following elective curative resection of colorectal carcinoma increase local and distant tumor recurrence rates as well as tumor related mortality. Complications developing after colorectal surgery endanger not only the immediate postoperative period, but long term survival is also threatened due to its oncological effect.
authors.affiliation: Petz Aladár Megyei Oktató Kórház, Sebészeti Centrum, Györ. peter.zsoldos@yahoo.com
authors.forename: Péter
authors.initials: P
authors.lastname: Zsoldos
authors.forename: László
authors.initials: L
authors.lastname: Hegedüs
authors.forename: Akos
authors.initials: A
authors.lastname: Issekutz
authors.forename: Attila
authors.initials: A
authors.lastname: Oláh
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003082:Colectomy / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000556:secondary