title: The impact of postoperative complications on long-term quality of life after curative colorectal cancer surgery.
abstract: OBJECTIVE
  To investigate the effect that complications have on patients' long-term quality of life (QoL) after curative colorectal cancer surgery.
  
  
  BACKGROUND
  Colorectal cancer surgery is a high risk, with approximately 1 in 3 patients suffering a complication. The long-term consequences of postoperative complications are important but have poorly been documented.
  
  
  METHODS
  The MRC-CLASICC trial (laparoscopic-assisted vs open surgery for colorectal cancer) included prospective evaluation of QoL using validated scoring questionnaires: EORTC QLQ-C30/CR38 and EQ5D. These were used to compare QoL at 3, 6, 18, and 36 months to baseline values for patients categorized into 2 groups: (i) those suffering any complication and (ii) those suffering any of 5 common complications (wound, chest, anastomotic leak, hemorrhage, and cardiac event).
  
  
  RESULTS
  A total of 614 of 794 CLASICC patients were suitable for inclusion. Complications occurred in 215 (35.0%) patients, including: wound complications (61, 9.9%), chest infection (50, 8.1%), anastomotic leak (27, 4.4%), hemorrhage (14, 2.3%), and cardiac event (26, 4.2%). Significant long-term differences in QoL between patients with and without complications were found for Physical and Social Function, Role Functioning, and Body Image on EORTC QLQ-C30/QLQ-CR38 analysis and Mobility, Self-care, and Pain/Discomfort on EQ5D analysis. No significant differences were seen for emotional/cognitive functioning, global QoL, financial difficulties, or future perspectives. Risk factors of age, gender, ASA (American Society of Anesthesiologists) grade, and stoma moderated the impact of complications in the short- to medium-term QoL, but had less influence on long-term QoL.
  
  
  CONCLUSIONS
  Postoperative complications have adverse effects on long-term QoL, particularly for Physical, Role and Social Functioning, and Body Image, as well as for Mobility, Self-care, and Pain/Discomfort. These findings should inform future preoperative counseling and health care planning.
authors.affiliation: *Clinical Trials Research Unit and †Leeds Institute of Molecular Medicine, University of Leeds; ‡John Goligher Colorectal Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Brown
authors.forename: Ronnie
authors.initials: R
authors.lastname: Mathew
authors.forename: Ada
authors.initials: A
authors.lastname: Keding
authors.forename: Helen C
authors.initials: HC
authors.lastname: Marshall
authors.forename: Julia M
authors.initials: JM
authors.lastname: Brown
authors.forename: David G
authors.initials: DG
authors.lastname: Jayne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology