title: Prior Abdominal Surgery Jeopardizes Quality of Resection in Colorectal Cancer.
abstract: BACKGROUND
  Prior abdominal surgery increases complexity of abdominal operations. Effort to prevent injury during adhesiolysis might result in less extensive bowel resection in colorectal cancer surgery. The aim of this study was to evaluate the effect of prior abdominal surgery on the outcome of colorectal cancer surgery.
  
  
  METHODS
  A nationwide prospective database of patients with primary colorectal cancer resection in The Netherlands between 2010 and 2012 was reviewed for histopathology, morbidity and mortality in patients with compared to patients without prior abdominal surgery.
  
  
  RESULTS
  9042 patients with and 17,679 without prior abdominal surgery were analyzed. After prior abdominal surgery 20.7 % had less than 10 lymph nodes in the histopathological specimen compared to 17.8 % without prior abdominal surgery (adjusted OR 1.17, 95 % CI 1.09-1.26). Adjusted ORs for less than 10 and 12 lymph nodes were significant in colon cancer resection and not in rectal cancer resection. Subgroups of patients who had previous hepatobiliary surgery or other abdominal surgery had a higher incidence of inadequate number of harvested lymph nodes. Prior colorectal surgery increased the percentage of positive circumferential rectal resection margin by 64 % (12.5 and 7.6 %; adjusted OR 1.70, 95 % CI 1.21-2.39). For colon cancer morbidity was significantly higher in patients with prior surgery (33.2 and 29.7 %; adjusted OR 1.18, 95 % CI 1.10-1.26), 30-day mortality was comparable (4.7 % prior surgery and 3.8 % without prior surgery; adjusted OR 1.01, 95 % CI 0.88-1.17).
  
  
  CONCLUSIONS
  Prior abdominal surgery compromises the quality of resection and increases postoperative morbidity in patients with primary colorectal cancer.
authors.affiliation: Department of Surgery, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. martijn.stommel@radboudumc.nl.
authors.forename: Martijn W J
authors.initials: MW
authors.lastname: Stommel
authors.affiliation: Department of Surgery, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Johannes H W
authors.initials: JH
authors.lastname: de Wilt
authors.affiliation: Department of Surgery, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Richard P G
authors.initials: RP
authors.lastname: ten Broek
authors.affiliation: Department of Surgery, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Chema
authors.initials: C
authors.lastname: Strik
authors.affiliation: Department of Operating Rooms and Health Evidence, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Maroeska M
authors.initials: MM
authors.lastname: Rovers
authors.affiliation: Department of Surgery, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Harry
authors.initials: H
authors.lastname: van Goor
mesh_terms: D000368:Aged; D003082:Colectomy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D015996:Survival Rate / Q000639:trends