Influence of postoperative complications on relapse-free survival in gastrointestinal malignancies

A variety of preoperative variables-such as perforation prior to surgery, poor nutritional status, and comorbid conditions such as diabetes-are already known to shorten relapse-free survival in patients with gastrointestinal malignancies. However, the significance of postoperative events in gastrointestinal malignancies is still debated and has not been studied in the population of southern India.

A retrospective study was conducted at Kidwai Memorial Institute of Oncology, Bangalore, India, from September 2004 to 2006. Patients from a single surgical unit who had undergone surgery with curative intent for gastrointestinal malignancies were evaluated (to maintain uniformity, patients who had undergone palliative surgery were not included in the analysis). We assumed anastomotic leak, delayed wound healing, and postoperative weight loss > 10% as risk factors predictive of poor disease-free survival. These factors were evaluated in all patients, and risk for development of relapse was calculated.

A total of 236 patients were evaluated. Baseline parameters were similar in both groups. Compared with patients who developed no postoperative complications, we found that the risk of relapse is 9.8 times greater in patients having anastomotic leak, 8.2 times greater in those with delayed recovery, and 2.3 times greater in those having excessive weight loss. The risk was uniform in all types of gastrointestinal malignancies.

The results suggest that anastomotic leak, delayed wound healing, and postoperative weight loss in patients with gastrointestinal malignancies confer poor disease-free survival. The presence of these complications warrants closer follow-up and management as appropriate.