title: Cause of death the first year after curative colorectal cancer surgery; a prolonged impact of the surgery in elderly colorectal cancer patients.
abstract: BACKGROUND
  The 1-year mortality after colorectal cancer surgery is high and explains age related differences in colorectal cancer survival. To gain better insight in its etiology, cause of death for these patients was studied.
  
  
  METHODS
  All 1924 patients who had a resection for stage I-III colorectal cancer from 2006 to 2008 in the Western region of the Netherlands were identified. Data were merged with cause of death data from the Central Bureau of Statistics Netherlands. To calculate excess mortality as compared to the general population, national data were used.
  
  
  RESULTS
  Overall 13.2% of patients died within the first postoperative year. One-year mortality increased with age. It was as high as 43% in elderly patients that underwent emergency surgery. In 75% of patients, death was attributed to the colorectal cancer. In 25% of all patients, registered deaths were attributed to postoperative complications. Elderly patients with comorbidity more frequently died due to complications (p < 0.01). Death of other causes was similar to background mortality according to age group.
  
  
  CONCLUSIONS
  In the presently studied cohort of patients that died within one year of surgery, cause of death was predominantly attributed to colorectal cancer. However, because it is not to be expected that in this cohort the number of deaths from recurrences is very high, the excess 1-year mortality indicates a prolonged impact of the surgery, especially in elderly patients. Therefore, in these patients we should focus on limiting the physiological impact of the surgery and be more involved in the post-hospital period.
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands; Reinier de Graaf Gasthuis, Department of Surgery, Delft, The Netherlands. Electronic address: j.w.t.dekker@rdgg.nl.
authors.forename: J W T
authors.initials: JW
authors.lastname: Dekker
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: Gooiker
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands.
authors.forename: C B M
authors.initials: CB
authors.lastname: van den Broek
authors.affiliation: Comprehensive Cancer Centre the Netherlands (CCCNL), Utrecht, The Netherlands.
authors.forename: L G M
authors.initials: LG
authors.lastname: van der Geest
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands.
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Liefers
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015897:Comorbidity; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009426:Netherlands; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: 1-year mortality; Cause of death; Colorectal cancer surgery; Elderly