Surgical outcomes of colorectal cancer surgery in transplant recipients: A matched case-control study

The incidence of colorectal carcinoma (CRC) in transplant (TX) recipients is higher than in the general population. Registry data indicate inferior oncological outcomes for this population. While the general surgical risk is increased in TX recipients, the risk associated with elective CRC surgery in this population is not well investigated.

TX recipients, who underwent elective surgical treatment for CRC at our specialized centre from 2008 to 2024 were included in this case-control study. The controls were randomly selected from our CRC database and matched according to tumour location and Charlson Comorbidity Index. Outcomes assessed included intensive care unit stay, in-hospital mortality, length of hospital stay and major morbidity (defined as Clavien-Dindo Grade ≥3).

The study included 24 TX recipients. Ten patients had had either liver or kidney TX, three patients had undergone lung TX and one patient heart TX. The mean time interval between transplantation surgery and CRC was 8.82 years. Morbidity was significantly higher in the TX group (54.2% vs. 8.3%, P = 0.001; OR 13.0, 95% CI 2.5-68,1, P = 0.002) and length of hospital stay was significantly longer (25 vs. 9 days, P = 0.001; OR 9.09, 95% CI 1.4-16.7, P = 0.022) for TX patients. No significant differences in mortality and intensive care unit stay were observed.

The risk of surgery for CRC in TX patients is significantly increased. Treatment decisions should involve TX experts to develop a tailored and considered treatment plan.