Impact of complications on long-term survival after resection of colorectal liver metastases.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Department of Surgery, Johns Hopkins University School of Medicine, Blalock 688, 600 North Wolfe Street, Baltimore, Maryland 21287, USA.
M N
MN
Mavros
M
M
de Jong
E
E
Dogeas
O
O
Hyder
T M
TM
Pawlik
D000368:Aged; D003110:Colonic Neoplasms; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D012004:Rectal Neoplasms; D012189:Retrospective Studies; D016896:Treatment Outcome