title: Association Between the Most Frequent Complications After Surgery for Stage I-III Colon Cancer and Short-Term Survival, Long-Term Survival, and Recurrences.
abstract: The purpose of this study was to identify the ten most frequent complications after surgery for stage I-III colon cancer and to assess the association between these complications and overall survival, conditional overall survival, and recurrences.
  
  
  
  All patients who underwent surgery for stage I-III colon cancer in five hospitals in the Western region of the Netherlands were identified. Crude and adjusted Cox proportional hazards models were used to study the association between complications and 1-year overall survival, 5-year overall survival, 5-year conditional overall survival, and 5-year disease-free period.
  
  
  
  Data from 761 patients were used for the analyses. Complications were associated with decreased 1-year overall survival (hazard ratio (HR) 2.87, 95 % confidence interval (CI) 1.82-4.51; p < 0.001), 5-year overall survival (HR 1.59, 95 % CI 1.25-2.04; p < 0.001), and 5-year conditional overall survival (HR 1.34, 95 % CI 1.06-1.69; p = 0.016), whereas an increasing number of complications had no additional impact. Anastomotic leakage, excessive blood loss, and (abdominal) sepsis were associated with reduced 1-year overall survival, anastomotic leakage, delirium, abscess, and (abdominal) sepsis with reduced 5-year overall survival, and anastomotic leakage, delirium, and abscess with reduced 5-year conditional overall survival. Anastomotic leakage, electrolyte disorders, and abscess were risk factors for recurrence within five years.
  
  
  
  Our results demonstrate the serious impact of the most frequent complications after surgery for colon cancer on short-term and long-term outcomes. This study confirms the prolonged impact of surgery and demonstrates that complications result not only in reduced 1-year survival, but also in reduced long-term outcomes.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. a.j.breugom@lumc.nl.
authors.forename: A J
authors.initials: AJ
authors.lastname: Breugom
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: D T
authors.initials: DT
authors.lastname: van Dongen
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.|Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Bastiaannet
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: F W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
authors.forename: L G M
authors.initials: LG
authors.lastname: van der Geest
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Liefers
authors.affiliation: Department of Surgery, Medical Centre Haaglanden, The Hague, The Netherlands.
authors.forename: A W K S
authors.initials: AW
authors.lastname: Marinelli
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: W E
authors.initials: WE
authors.lastname: Mesker
authors.affiliation: Department of Internal Medicine, HAGA Hospital, The Hague, The Netherlands.
authors.forename: J E A
authors.initials: JE
authors.lastname: Portielje
authors.affiliation: Department of Surgery, HAGA Hospital, The Hague, The Netherlands.
authors.forename: W H
authors.initials: WH
authors.lastname: Steup
authors.affiliation: Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.
authors.forename: L N L
authors.initials: LN
authors.lastname: Tseng
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: C J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.
authors.forename: J W T
authors.initials: JW
authors.lastname: Dekker
mesh_terms: D000038:Abscess / Q000209:etiology; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D001145:Arrhythmias, Cardiac / Q000209:etiology; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D003693:Delirium / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D045823:Ileus / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D016016:Proportional Hazards Models; D018805:Sepsis / Q000209:etiology; D015996:Survival Rate; D013997:Time Factors; D014552:Urinary Tract Infections / Q000209:etiology; D014883:Water-Electrolyte Imbalance / Q000209:etiology