Impact of Postoperative Complications on Oncologic Outcomes After Rectal Cancer Surgery: An Analysis of the US Rectal Ca
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ORIGINAL ARTICLE – COLORECTAL CANCER
Impact of Postoperative Complications on Oncologic Outcomes After Rectal Cancer Surgery: An Analysis of the US Rectal Cancer Consortium Adriana C. Gamboa, MD, MS1, Rachel M. Lee, MD, MSPH1, Michael K. Turgeon, MD1, Christopher Varlamos, BS2, Scott E. Regenbogen, MD2, Katherine A. Hrebinko, MD3, Jennifer Holder-Murray, MD3, Jason T. Wiseman, MD4, Aslam Ejaz, MD4, Michael P. Feng, BA5, Alexander T. Hawkins, MD5, Philip Bauer, MD6, Matthew Silviera, MD6, Shishir K. Maithel, MD1, and Glen C. Balch, MD, MBA7 Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA; 2Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI; 3Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; 4Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH; 5Section of Colon and Rectal Surgery, Division of General Surgery, Vanderbilt University Medical Center, Nashville, TN; 6Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; 7Division of Colon and Rectal Surgery, Department of Surgery, Emory University, Atlanta, GA 1
ABSTRACT Background. Postoperative complications (POCs) are associated with worse oncologic outcomes in several cancer types. The implications of complications after rectal cancer surgery are not well studied. Methods. The United States Rectal Cancer Consortium (2007–2017) was reviewed for primary rectal adenocarcinoma patients who underwent R0/R1 resection. Ninety-day POCs were categorized as major or minor and were grouped into infectious, cardiopulmonary, thromboembolic, renal, or intestinal dysmotility. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS). Results. Among 1136 patients, the POC rate was 46% (n = 527), with 63% classified as minor and 32% classified as major. Of all POCs, infectious complications comprised 20%, cardiopulmonary 3%, thromboembolic 5%, renal 9%,
Meeting Presentation 2020 Society of Surgical Oncology. Ó Society of Surgical Oncology 2020 First Received: 18 May 2020 Accepted: 10 July 2020 G. C. Balch, MD, MBA e-mail: [email protected]
and intestinal dysmotility 19%. Compared with minor or no POCs, major POCs were associated with both worse RFS and worse OS (both p \ 0.01). Compared with no POCs, a single POC was associated with worse RFS (p \ 0.01), while multiple POCs were associated with worse OS (p = 0.02). Regardless of complication grade, infectious POCs were associated with worse RFS (p \ 0.01), while cardiopulmonary and thromboembolic POCs were associated with worse OS (both p \ 0.01). Renal POCs were associated with both worse RFS (p \ 0.001) and worse OS (p = 0.01). After accounting for pathologic stage, neoadjuvant therapy, and final margin status, Multivariable analysis (MVA) demonstrated worse outcomes with cardiopulmonary, thromboembolic, and renal POCs for OS (cardiopulmonary: hazard ra
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