Postoperative Complications and Long-Term Survival After Complex Cancer Resection.
BACKGROUND
Recent attention has focused on the ability to rescue patients from postoperative complications and prevent short-term mortality. However, it is unknown whether patients rescued from complications after complex cancer resections have long-term survival outcomes similar to those of patients without complications.


METHODS
From 2005 to 2009 Surveillance, Epidemiology, and End Results (SEER)-Medicare data, the study identified elderly patients who underwent resection for cancers of the esophagus, lung, or pancreas. The association of risk-adjusted long-term survival with serious complications, minor complications, and no complications was analyzed.


RESULTS
The study included 905 patients with esophageal cancer, 12,395 patients with lung cancer, and 1966 patients with pancreatic cancer. The serious complication rates were respectively 17.4, 9.5 and 11.8 %. The patients with serious complications had lower 5-year survival rates than those with no complications even if they were rescued and survived 30 days (20 vs 43 % for esophagus, 29 vs 54 % for lung, and 10 vs 21 % for pancreas cancer). Even after patients who died within 180 days after surgery were excluded from the analysis, a decrement in risk-adjusted long-term survival was observed among the patients with serious complications after all three procedures. The association between complications and long-term survival was not explained by differences in receipt of adjuvant chemotherapy CONCLUSION: Patients who undergo complex cancer resection and experience serious complications have diminished long-term survival, even if they are "rescued" from their complications. This finding persists even when deaths within 6 months after surgery are excluded from the analysis. Metrics of surgical success should consider terms beyond 30 and even 90 days as well as the long-term consequences of surgical complications.
Department of Surgery, University of Michigan, Ann Arbor, MI, USA. drnathan@umich.edu.
Hari
H
Nathan
Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Huiying
H
Yin
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Sandra L
SL
Wong
D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D018426:SEER Program; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D014481:United States / Q000453:epidemiology