Relaparotomy in colorectal cancer surgery--do any factors influence the risk of mortality? A case controlled study

Identification of the incidence of relaparotomy after operations for colorectal cancer and finding out factors influencing the incidence of relaparotomy and risk of mortality.

In the period from 2008 to 2012 the group of patients electively operated on for colorectal cancer was analysed. The database of the surgical department was reviewed retrospectively to search relaparotomies performed in perioperative period. We compared the risk of mortality and of reoperations according to clinical and demographic pre- and postoperative factors, tumour location and extend of surgery.

The group of 1674 patients was electively operated on for colorectal cancer and 121 (7.2%) relaparotomies were identified and analysed (77 males, 44 females, mean age of 65.1). In the whole group the risk of relaparotomy was higher in males OR 1.68; 95%CI 1.15-2.47; p = 0.008 and in patients with ASA III/IV OR 1.54; 95% CI 1.05-2.27; p = 0.027. The overall mortality rate was higher in patients after relaparotomy than after the only initial procedure 13.2% vs. 1.4%; with higher risk of mortality OR 9.78; 95%CI 4.97-19.29; p = 0.0008. The rate of anastomotic leak requiring reoperation was 2.7%. In resection procedures the incidence of reoperation was significantly higher 8.1% vs. 3.5%; p = 0.007, without any influence on mortality OR 0.7; 95%CI 0.14-3.49; p = 0.656. In reoperated patients mortality rate was the highest if the tumour was primary located in left colon than in the rectum an right colon (44.4% vs. 10.9% vs. 6.7%; p = 0.04). Anastomotic leak significantly increased the risk of mortality OR 2.95; 95%CI 1.00-8.39; p = 0.048. The risk of mortality was also higher in patients at age >65 OR 7.70; 95%CI 1.67-35.57; p = 0.009 and when ASA score was III or IV OR 5.83; 95%CI 1.58-21.60; p = 0.008.

Patients after relaparotomy for complications of colorectal cancer surgery are at very high risk of mortality. Particularly male gender, older age, poor general condition and anastomotic complications are the risk factors of high mortality.