title: Effects of postoperative morbidity on long-term outcome following surgery for colorectal liver metastases.
abstract: BACKGROUND
  The impact of postoperative complications on long-term outcomes after surgery for colorectal liver metastases (CRLM) remains controversial. During the last decade, advances in surgical as well as non-surgical treatment have increased resectability and altered outcomes. We sought to determine the influence of postoperative morbidity on disease-free (DFS) and overall survival (OS).
  
  
  METHODS
  All patients undergoing liver resection for CRLM for the first time between 2000 and 2011 were retrospectively identified from a prospective database. Postoperative morbidity was classified according to Dindo-Clavien grade. A Dindo-Clavien grade ≥ 3a was considered a major complication. Primary outcomes were DFS and OS depending on the presence or absence of postoperative morbidity.
  
  
  RESULTS
  Of the 266 included patients, 97 patients (37 %) developed postoperative complications, of whom 61 (23 %) had major complications. Median DFS and OS (5-year) were 17 and 53 months (42 %). The occurrence of postoperative morbidity did not significantly shorten OS (p = 0.130) and DFS (p = 0.101). However, major morbidity reduced DFS significantly (p < 0.05).
  
  
  CONCLUSIONS
  In the present study, the occurrence of major postoperative complications was associated with diminished DFS. However, the effect of (major) complications on OS did not reach statistical significance.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands, t.lodewick@maastrichtuniversity.nl.
authors.forename: T M
authors.initials: TM
authors.lastname: Lodewick
authors.forename: M C
authors.initials: MC
authors.lastname: de Jong
authors.forename: R M
authors.initials: RM
authors.lastname: van Dam
authors.forename: M H A
authors.initials: MH
authors.lastname: Bemelmans
authors.forename: U P
authors.initials: UP
authors.lastname: Neumann
authors.forename: S W M
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: C H C
authors.initials: CH
authors.lastname: Dejong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult