4.6 Article

Prolonged postoperative length of stay may be a valuable marker for susceptibility to relapse beyond established risk factors in patients with stage III colon cancer

Journal

WORLD JOURNAL OF SURGICAL ONCOLOGY
Volume 20, Issue 1, Pages -

Publisher

BMC
DOI: 10.1186/s12957-022-02742-8

Keywords

Colonic neoplasm; Postoperative length of stay; Prognostic risk factor; Disease-free survival

Funding

  1. University of Gothenburg
  2. Swedish Cancer Society [CAN 2015/499]
  3. Swedish government [ALFGBG-426941]
  4. county councils, and the ALF agreement [ALFGBG-426941]
  5. Swedish state under the ALF agreement [ALFGBG-874451, ALFGBG-784211]
  6. Bengt Ihre Foundation

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Prolonged postoperative length of stay (LOS) is associated with increased risk of recurrence and shorter disease-free survival (DFS) in patients with stage III colon cancer, regardless of whether adjuvant chemotherapy is given. Factors such as age, comorbidity, complications, and tumor features also play a role in this correlation.
Background Delay from surgery to adjuvant chemotherapy causes impaired survival among patients undergoing radical resection for stage III colon cancer, and the underlying mechanism for this is incompletely clarified. It is established that prolonged postoperative hospital length of stay (LOS) is associated with delayed initiation of the adjuvant treatment driving the assumption that prolonged LOS is prognostically unfavorable due to this fact and case mix factors. We hypothesize that prolonged LOS after surgery is a valuable marker for susceptibility to relapse that is not detected in established prognostic factors and, alone, associated with a shorter disease-free survival (DFS). Materials and methods A total of 690 consecutive patients undergoing elective radical resection for stage III colon cancer in 2000-2015 were identified in a prospective detailed facility database. Univariate and multivariate analyses were performed using Cox proportional hazards model in the evaluation of LOS as an independent prognostic factor. Results Short postoperative LOS, low comorbidity, and few complications were associated with longer DFS (p < 0.01). Fewer patients in the short and intermediate LOS groups had a relapse in their disease (28% and 33%, respectively), compared to the patients with longer LOS (40%, p < 0.05). LOS was a prognostic factor for DFS in the unadjusted univariate model (HR 1.04 per unit change) and remained statistically significant in the adjusted multivariate analysis, with a HR of 1.03 per hospital day (p < 0.01). Conclusions Postoperative LOS independently correlates with the risk of recurrence and DFS, regardless of if adjuvant chemotherapy is given, along with the factors such as age, comorbidity, complications, and tumor features. We propose a further investigation into the causal mechanisms based on tumor and host biology linking LOS to DFS beyond established risk factors.

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