title: Influence of comorbidity in cancer surgery on treatment decisions, postoperative course and oncological outcome.
abstract: OBJECTIVE
  Comorbidity in cancer patients may influence treatment decisions, postoperative morbidity and ultimately, survival. The TNM staging system does not take comorbidity into account. This study investigates the burden of comorbidity in cancer patients, its effect on resection rate, postoperative morbidity, adjuvant therapy, recurrence and survival.
  
  
  METHODS
  This prospective cohort study included 358 patients with potentially operable cancer. Pretreatment comorbidity was assessed using a modified Kaplan-Feinstein index (adult comorbidity evaluation-27) and its influence on resection rate and postoperative adjuvant therapy was assessed. The comorbidity grade was consolidated with TNM stage into four distinct groups that were compared for differences in the incidence of postoperative complications, duration of hospital stay, 30-day mortality, recurrence and survival.
  
  
  RESULTS
  Cardiovascular diseases including hypertension (27%) and diabetes mellitus (12%) were the most common comorbidities. Comorbidity did not influence the resection rate, but affected adjuvant treatment (P < 0.01). There was a greater incidence of postoperative local and systemic complications and duration of hospital stay in patients with comorbidity. Recurrence rates were unaffected. Mortality in patients with comorbidity was greater, especially postoperative 30-day mortality, but this was statistically insignificant.
  
  
  CONCLUSIONS
  Comorbidity increases postoperative morbidity and affects adjuvant therapy, although the resection rate is not influenced. The greater percentage of deaths in patients with comorbidity warrants further studies. Recurrence rates remain unaffected. However, a longer period of follow up is needed for a clearer picture.
authors.affiliation: Department of Surgical Oncology, MNB Cancer Institute, Inlaks-Budhrani Hospital, Pune, Maharashtra, India. rahulkchaudhary@rediffmail.com
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Chaudhary
authors.forename: Debanshu
authors.initials: D
authors.lastname: Bhaduri
authors.forename: Manish
authors.initials: M
authors.lastname: Bhatia
authors.forename: Sharanabasappa
authors.initials: S
authors.lastname: Hatti
authors.forename: Roshan
authors.initials: R
authors.lastname: Ba
authors.forename: Jignesh
authors.initials: J
authors.lastname: Meva
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology*; D015897:Comorbidity; D003657:Decision Making; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology*; D007194:India / Q000453:epidemiology; D007902:Length of Stay; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D062606:Tertiary Care Centers