BACKGROUND: Limited information is available on predictors of postoperative mortality, morbidity, and long-term survival in patients with stage IV colorectal cancer. OBJECTIVE: This study aimed to identify independent predictors of postoperative mortality and morbidity as well as independent predictors of long-term survival. DESIGN: This study was planned as a retrospective single-institution review. SETTING: This study took place at the Department of Surgery, The Royal Brisbane and Women's Hospital, Australia, between 1984 and 2004. PARTICIPANTS: Prospectively collected data were extracted from the records of 1867 patients undergoing treatment for colorectal cancer. The outcomes for 379 patients undergoing surgical resection of their primary colon or rectal tumor in the presence of unresectable synchronous metastases were analyzed. MAIN OUTCOME MEASURES: Independent predictive factors for postoperative mortality and morbidity as well as long-term survival were assessed by use of logistic regression and Cox regression analysis. RESULTS: Thirty-five (9.2%) patients died in the postoperative period and morbidity was 48.3%. Median survival was 11 months. Thirty-day postoperative mortality was independently associated with medical complications (P < .001), emergency operations (P = .001), female sex (P = .002), and age (≥ 70; P = .007) on regression analysis. Elderly (≥ 70) patients with either advanced local disease or extrahepatic metastases were at a particularly high risk. Preoperative predictors of surgical morbidity included male sex (P = .028) and advanced local disease (P = .036). Preoperative predictors of medical complications included repeat operations (P < .001), elevated urea levels (P = .017), and emergency operations (P = .003). Independent factors associated with poor overall survival included medical complications (P < .001), nodal stage (N2) (P = .004), poor tumor differentiation (P = .006), and apical lymph node involvement (P = .042). A subgroup of patients with advanced nodal disease (N2) and a poor tumor differentiation had a significantly poorer prognosis. LIMITATIONS: This study was limited by its retrospective nature. CONCLUSION: Elderly patients with advanced local disease or extrahepatic metastases are at high risk of 30-day postoperative mortality. Significant nodal disease and poor tumor differentiation are important predictors of long-term survival.
BACKGROUND: Limited information is available on predictors of postoperative mortality, morbidity, and long-term survival in patients with stage IV colorectal cancer. OBJECTIVE: This study aimed to identify independent predictors of postoperative mortality and morbidity as well as independent predictors of long-term survival. DESIGN: This study was planned as a retrospective single-institution review. SETTING: This study took place at the Department of Surgery, The Royal Brisbane and Women's Hospital, Australia, between 1984 and 2004. PARTICIPANTS: Prospectively collected data were extracted from the records of 1867 patients undergoing treatment for colorectal cancer. The outcomes for 379 patients undergoing surgical resection of their primary colon or rectal tumor in the presence of unresectable synchronous metastases were analyzed. MAIN OUTCOME MEASURES: Independent predictive factors for postoperative mortality and morbidity as well as long-term survival were assessed by use of logistic regression and Cox regression analysis. RESULTS: Thirty-five (9.2%) patients died in the postoperative period and morbidity was 48.3%. Median survival was 11 months. Thirty-day postoperative mortality was independently associated with medical complications (P < .001), emergency operations (P = .001), female sex (P = .002), and age (≥ 70; P = .007) on regression analysis. Elderly (≥ 70) patients with either advanced local disease or extrahepatic metastases were at a particularly high risk. Preoperative predictors of surgical morbidity included male sex (P = .028) and advanced local disease (P = .036). Preoperative predictors of medical complications included repeat operations (P < .001), elevated urea levels (P = .017), and emergency operations (P = .003). Independent factors associated with poor overall survival included medical complications (P < .001), nodal stage (N2) (P = .004), poor tumor differentiation (P = .006), and apical lymph node involvement (P = .042). A subgroup of patients with advanced nodal disease (N2) and a poor tumor differentiation had a significantly poorer prognosis. LIMITATIONS: This study was limited by its retrospective nature. CONCLUSION: Elderly patients with advanced local disease or extrahepatic metastases are at high risk of 30-day postoperative mortality. Significant nodal disease and poor tumor differentiation are important predictors of long-term survival.
Authors: Constantinos Simillis; Eliana Kalakouti; Thalia Afxentiou; Christos Kontovounisios; Jason J Smith; David Cunningham; Michel Adamina; Paris P Tekkis Journal: World J Surg Date: 2019-07 Impact factor: 3.352
Authors: Louis de Mestier; Gilles Manceau; Cindy Neuzillet; Jean Baptiste Bachet; Jean Philippe Spano; Reza Kianmanesh; Jean Christophe Vaillant; Olivier Bouché; Laurent Hannoun; Mehdi Karoui Journal: World J Gastrointest Oncol Date: 2014-06-15
Authors: Seon Jeong Jeong; Yong Sik Yoon; Jung Bok Lee; Jong Lyul Lee; Chan Wook Kim; In Ja Park; Seok Byung Lim; Chang Sik Yu; Jin Cheon Kim Journal: Surg Today Date: 2016-08-22 Impact factor: 2.549
Authors: Vincent W T Lam; Jerome M Laurence; Tony Pang; Emma Johnston; Michael J Hollands; Henry C C Pleass; Arthur J Richardson Journal: HPB (Oxford) Date: 2013-03-19 Impact factor: 3.647
Authors: Laurence E McCahill; Greg Yothers; Saima Sharif; Nicholas J Petrelli; Lily Lau Lai; Naftali Bechar; Jeffrey K Giguere; Shaker R Dakhil; Louis Fehrenbacher; Samia H Lopa; Lawrence D Wagman; Michael J O'Connell; Norman Wolmark Journal: J Clin Oncol Date: 2012-08-06 Impact factor: 44.544