Risk of Life-Threatening Complications After Colorectal Cancer Surgery: A Japanese Multicenter Study

As the population ages, more surgeries are being performed on patients in poor general condition. Such patients are at greater risk of life-threatening postoperative complications and perioperative mortality.

This multicenter study investigated 4164 consecutive patients who underwent colorectal surgery between 2016 and 2023. Patients were divided into those who experienced life-threatening complications (LT group, n = 31) and those who did not (no-LT group, n = 4133). Clinical features were compared between groups.

Thirty-one patients (0.7%) experienced life-threatening complications. Age was higher (80 years vs. 71 years, p = 0.011), body mass index was lower (19.7 kg/m² vs. 22.0 kg/m², p < 0.001), poor performance status (performance status ≥ 3) was more frequent (54.8% vs. 10.4%, p < 0.001), and open surgery was more frequent (25.8% vs. 9.0%, p < 0.001) in the LT group. Multivariate analysis revealed high age (odds ratio 2.268, 95% confidence interval 1.079-4.763; p = 0.030), poor performance status (odds ratio 7.714, 95% confidence interval 3.622-11.251; p < 0.001) and open surgery (odds ratio 1.792, 95% confidence interval 1.205-6.799; p = 0.016) as independent predictors of life-threatening complications.

Patients with a risk of life-threatening complications should be given a detailed preoperative description of the risks, and indications and approaches to surgery should be thoroughly examined.