The Impact of Postoperative Complications After Colon Cancer Surgery on Locoregional Recurrence: A Population-Based...

In contrast to rectal cancer, the influence of postoperative complications on locoregional recurrence (LRR) in colon cancer is understudied, with conflicting reports. This study aimed to determine the impact of postoperative complications on LRR and overall survival (OS) in colon cancer.

This population-based cross-sectional cohort study was carried out in 50 Dutch hospitals. Patients who underwent resection for stage I-III colon cancer between January 2014 and December 2015 were eligible. LRR comprised any intraabdominal recurrence, including peritoneal metastases.

A total of 7983 patients were included with a median follow-up of 62.5 months (interquartile range 58.1-80.3). Postoperative complications occurred in 2239 (28.0%) patients and included anastomotic leakage requiring re-intervention in 394 (4.9%), any other surgical complication in 944 (11.8%), and only non-surgical complications in 901 patients (11.3%). The 5-year LRR rate was 13.5%, 8.8% and 8.8%, respectively, as compared with 6.8% in patients without complications (Fine-Gray p<0.001). Only anastomotic leakage was an independent risk factor for LRR (cause-specific hazard ratio [HR] 1.45 [95% confidence interval (CI) 1.07-1.96]). Five-year OS probability was 78.9% for patients without complications versus 71.1%, 68.5%, and 62.7% for patients with anastomotic leakage, any other surgical complication, and non-surgical complications only, respectively (log-rank p<0.001). Both surgical and non-surgical complications were an independent risk factor for worse OS (HR 1.12 [95% CI 1.00-1.26); HR 1.21 [95% CI 1.08-1.36], respectively).

This study demonstrates an increased risk of LRR after all types of postoperative complications in patients with stage I-III colon cancer, but only anastomotic leakage remained independently associated with LRR. Both surgical and non-surgical complications were associated with worse OS.