eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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3/2018
vol. 13
 
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abstract:
Original paper

Postoperative complications are associated with worse survival after laparoscopic surgery for non-metastatic colorectal cancer – interim analysis of 3-year overall survival

Michał Nowakowski, Magdalena Pisarska, Mateusz Rubinkiewicz, Grzegorz Torbicz, Natalia Gajewska, Magdalena Mizera, Piotr Major, Paweł Potocki, Dorota Radkowiak, Michał Pędziwiatr

Videosurgery Miniinv 2018; 13 (3): 326–332
Online publish date: 2018/06/08
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Introduction
Postoperative morbidity after colorectal resections for cancer remains a significant problem. Data on the influence of complications on survival after laparoscopic colorectal resection are still limited.

Aim
To analyze the impact of postoperative complications on long-term survival after radical laparoscopic resection for colorectal cancer.

Material and methods
Two hundred and sixty-five consecutive non-metastatic colorectal cancer patients undergoing laparoscopic colorectal resection for cancer were included in the analysis. The entire study group was divided into two subgroups based on the occurrence of postoperative complications. Group 1 included patients without postoperative morbidity and group 2 included patients with complications. The primary outcome was overall survival.

Results
Median follow-up was 45 (IQR: 34–55) months. Group 1 consisted of 187 (70.5%) patients and group 2 comprised 78 (29.5%) patients. Studied groups were comparable in terms of sex, age, body mass index, ASA class, cancer staging, localization of the tumor and operative time. Patients in group 1 had significantly better overall 3-year survival compared to those with complications (84.9% vs. 69.8%, p = 0.022). Kaplan-Meier curves showed significantly improved survival rates in patients without complications compared with complicated cases. The Cox proportional multivariate model showed that postoperative complications (HR = 2.83; 95% CI: 1.35–5.92; p = 0.0058) and AJCC III (HR = 3.17; 95% CI: 1.52–6.6; p = 0.0021) were independent predictors of worse survival after laparoscopic colorectal cancer surgery.

Conclusions
Our analysis of interim results after 3 years confirms that complications after laparoscopic colorectal cancer surgery have an impact on survival. For this reason, these patients should be carefully monitored after surgery aiming at early detection of recurrence.

keywords:

laparoscopy, colorectal cancer, survival, postoperative complications

references:
Hendren S, Birkmeyer JD, Yin H, et al. Surgical complications are associated with omission of chemotherapy for stage III colorectal cancer. Dis Colon Rectum 2010; 53: 1587-93.
Cohen ME, Bilimoria KY, Ko CY, Hall BL. Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery. J Am Coll Surg 2009; 208: 1009-16.
Law WL, Poon JTC, Fan JKM, Lo OSH. Survival following laparoscopic versus open resection for colorectal cancer. Int J Colorectal Dis 2012; 27: 1077-85.
Sjo OH, Larsen S, Lunde OC, Nesbakken A. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 2009; 11: 733-9.
Kwiatkowski A, Stępińska G, Stanowski E, Paśnik K. Implementation of laparoscopic approach in colorectal surgery – a single center’s experience. Videosurgery Miniinv 2018; 13: 27-32.
Wierdak M, Pisarska M, Kuśnierz-Cabala B, et al. Changes in plasma albumin levels in early detection of infectious complications after laparoscopic colorectal cancer surgery with ERAS protocol. Surg Endosc 2018; in press.
Pędziwiatr M, Wierdak M, Nowakowski M, et al. Cost minimization analysis of laparoscopic surgery for colorectal cancer within the enhanced recovery after surgery (ERAS) protocol: a single-centre, case-matched study. Videosurgery Miniinv 2016; 11: 14-21.
Merkow RP, Bentrem DJ, Mulcahy MF, et al. Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer. Ann Surg 2013; 258: 847-53.
Cheung WY, Neville BA, Earle CC. Etiology of delays in the initiation of adjuvant chemotherapy and their impact on outcomes for stage II and III rectal cancer. Dis Colon Rectum 2009; 52: 1054-63.
Poylin V, Curran T, Lee E, Nagle D. Laparoscopic colectomy decreases the time to administration of chemotherapy compared with open colectomy. Ann Surg Oncol 2014; 21: 3587-91.
Ptok H, Marusch F, Meyer F, et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 2007; 94: 1548-54.
Law WL, Choi HK, Lee YM, Ho JWC. The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol 2007; 14: 2559-66.
Pędziwiatr M, Kisialeuski M, Wierdak M, et al. Early implementation of Enhanced Recovery After Surgery (ERAS®) protocol – compliance improves outcomes: a prospective cohort study. Int J Surg 2015; 21: 75-81.
Pędziwiatr M, Pisarska M, Kisielewski M, et al. ERAS protocol in laparoscopic surgery for colonic versus rectal carcinoma: are there differences in short-term outcomes? Med Oncol 2016; 33: 56.
Pisarska M, Pędziwiatr M, Małczak P, et al. Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. Int J Surg 2016; 36: 377-82.
Dindo D. The Clavien-Dindo classification of surgical complications. Treat Postoper Complicat After Dig Surgery Springer, London 2014; 13-9.
Clavien PA, Barkun J, De Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009; 250: 187-96.
Berends FJ, Kazemier G, Bonjer HJ, Lange JF. Subcutaneous metastases after laparoscopic colectomy. Lancet 1994; 344: 58.
Wexner SD, Cohen SM. Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 1995; 82: 295-8.
Di B, Li Y, Wei K, et al. Laparoscopic versus open surgery for colon cancer: a meta-analysis of 5-year follow-up outcomes. Surg Oncol 2013; 22: e39-43.
Pędziwiatr M, Małczak P, Mizera M, et al. There is no difference in outcome between laparoscopic and open surgery for rectal cancer: a systematic review and meta-analysis on short- and long-term oncologic outcomes. Tech Coloproctol 2017; 21: 595-604.
Loftus EV, Delgado DJ, Friedman HS, Sandborn WJ. Colectomy and the incidence of postsurgical complications among ulcerative colitis patients with private health insurance in the United States. Am J Gastroenterol 2008; 103: 1737-45.
Peyrin-Biroulet L, Germain A, Patel AS, Lindsay JO. Systematic review: outcomes and post-operative complications following colectomy for ulcerative colitis. Aliment Pharmacol Ther 2016; 44: 807-16.
Zogg CK, Najjar P, Diaz AJR, et al. Rethinking priorities: cost of complications after elective colectomy. Ann Surg 2016; 264: 312-22.
Małczak P, Pisarska M, Piotr M, et al. Enhanced recovery after bariatric surgery: systematic review and meta-analysis. Obes Surg 2017; 27: 226-35.
Pisarska M, Małczak P, Major P, et al. Enhanced recovery after surgery protocol in oesophageal cancer surgery: systematic review and meta-analysis. PLoS One 2017; 12: e0174382.
Pedziwiatr M, Matłok M, Kisialeuski M, et al. Short hospital stays after laparoscopic gastric surgery under an enhanced recovery after surgery (ERAS) pathway: experience at a single center. Eur Surg - Acta Chir Austriaca 2014; 46: 128-32.
Kisialeuski M, Pędziwiatr M, Matłok M, et al. Enhanced recovery after colorectal surgery in elderly patients. Videosurgery Miniinv 2015; 10: 30-6.
Greco M, Capretti G, Beretta L, et al. Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 2014; 38: 1531-41.
Day AR, Middleton G, Smith RVP, et al. Time to adjuvant chemotherapy following colorectal cancer resection is associated with an improved survival. Colorectal Dis 2014; 16: 368-72.
Tevis SE, Kohlnhofer BM, Stringfield S, et al. Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival. Dis Colon Rectum 2013; 56: 1339-48.
Chau I. Adjuvant therapy in colon cancer: what, when and how? Ann Oncol 2006; 17: 1347-59.
Lohrisch C, Paltiel C, Gelmon K, et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol 2006; 24: 4888-94.
Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253: 890-9.
Eberhardt JM, Kiran RP, Lavery IC. The impact of anastomotic leak and intra-abdominal abscess on cancer-related outcomes after resection for colorectal cancer: a case control study. Dis Colon Rectum 2009; 52: 380-6.
Lin JK, Yueh TC, Chang SC, et al. The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer. J Gastrointest Surg 2011; 15: 2251-61.
Attiê R, Chinen LTD, Yoshioka EM, et al. Acute bacterial infection negatively impacts cancer specific survival of colorectal cancer patients. World J Gastroenterol 2014; 20: 13930-5.
Novitsky YW, Litwin DEM, Callery MP. The net immunologic advantage of laparoscopic surgery. Surg Endosc Other Interv Tech 2004; 18: 1411-9.
Ben-Eliyahu S. The promotion of tumor metastasis by surgery and stress: immunological basis and implications for psychoneuroimmunology. Brain Behav Immun 2003; 17 (1 Suppl.): S27-36.
Evans C, Galustian C, Kumar D, et al. Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors. Am J Surg 2009; 197: 238-45.
Torpy DJ, Ho JT. Value of free cortisol measurement in systemic infection. Horm Metab Res 2007; 39: 439-44.
Het S, Schoofs D, Rohleder N, Wolf OT. Stress-induced cortisol level elevations are associated with reduced negative affect after stress: indications for a mood-buffering cortisol effect. Psychosom Med 2012; 74: 23-32.
Sephton SE, Dhabhar FS, Keuroghlian AS, et al. Depression, cortisol, and suppressed cell-mediated immunity in metastatic breast cancer. Brain Behav Immun 2009; 23: 1148-55.
Matsuo K, Prather CP, Ahn EH, et al. Significance of perioperative infection in survival of patients with ovarian cancer. Int J Gynecol Cancer 2012; 22: 245-53.
  
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