title: Major postoperative complications following elective resection for colorectal cancer decrease long-term survival but not the time to recurrence.
abstract: OBJECTIVE
  The aim of the study was to determine the effect of major complications after colorectal cancer surgery on survival and time to recurrence.
  
  
  METHODS
  Patients having a curative colorectal cancer resection and a follow-up of at least 3 years were identified from a prospective database. Major complications were defined as Clavien-Dindo Grades 3b or 4 and their impact on time to recurrence and mortality was analysed by univariate and multivariable analysis. Postoperative death within 30 days or during the initial hospitalization (Clavien-Dindo Grade 5) was a priori excluded.
  
  
  RESULTS
  From 2003 to 2012, 868 colorectal cancer resections resulting in 63 (7%) major postoperative complications including deaths (Clavien-Dindo ≥ 3b) were identified. After exclusion of Grade 5 complications (postoperative or in-hospital deaths), 844 resections with 39 (5%) major complications remained for analysis. Median follow-up time was 5.7 years. Using the Kaplan-Meier method, the estimated crude 5-year overall survival probability was 78% (95% CI 75-81) in the group without and 65% (95% CI 51-83) in the group with major complications (P = 0.009, log-rank test). Major complications were a significant negative predictor for overall survival (hazard ratio 2.42, 95% CI 1.41-4.14) when adjusted for sex, age, American Society of Anesthesiologists grade, tumour site (colon vs rectum), R stage and tumour stage. However, in both univariate and multivariable analysis, major complications were not a significant predictor for time to recurrence (hazard ratio 1.29, 95% CI 0.56-2.99).
  
  
  CONCLUSIONS
  Non-lethal major postoperative complications seem to have a negative long-term impact on survival but not on time to recurrence.
authors.affiliation: Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-6665-9797
authors.initials: M
authors.lastname: Odermatt
authors.affiliation: Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: D
authors.initials: D
authors.lastname: Miskovic
authors.affiliation: Colorectal Department, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: K
authors.initials: K
authors.lastname: Flashman
authors.affiliation: Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: J
authors.initials: J
authors.lastname: Khan
authors.affiliation: Colorectal Department, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: A
authors.initials: A
authors.lastname: Senapati
authors.affiliation: Colorectal Department, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: D
authors.initials: D
authors.lastname: O'Leary
authors.affiliation: Colorectal Department, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: M
authors.initials: M
authors.lastname: Thompson
authors.affiliation: Minimally Invasive Colorectal Unit, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: A
authors.initials: A
authors.lastname: Parvaiz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Postoperative complications; colorectal; recurrence; survival