Impact of complications on long-term survival after resection of colorectal liver metastases

Background Postoperative complications may have an adverse effect not only on short-term but also long-term outcome among patients having surgery for cancer. A retrospective series of patients who had surgery for colorectal liver metastases (CLM) was used to assess this association. Methods Patients who had surgery with curative intent for CLM from 2000 to 2009 were included. The impact of postoperative complications, patient characteristics, disease stage and treatment on long-term survival was analysed using multivariable Cox regression models. Results A total of 251 patients were included. The median age was 58 (interquartile range 5168) years and there were 87 women (34 center dot 7 per cent). A minor or major postoperative complication developed in 41 and 14 patients respectively, and five patients (2 center dot 0 per cent) died after surgery. The 5-year recurrence-free (RFS) and overall survival rates were 19 center dot 5 and 41 center dot 9 per cent respectively. Multivariable analysis revealed that postoperative complications independently predicted shorter RFS (hazard ratio (HR) 2 center dot 36, 95 per cent confidence interval 1 center dot 56 to 3 center dot 58) and overall survival (HR 2 center dot 34, 1 center dot 46 to 3 center dot 74). Other independent predictors of shorter RFS and overall survival included lymph node metastasis, concomitant extrahepatic disease, a serum carcinoembryonic antigen level of at least 100 ng/dl, and the use of radiofrequency ablation (RFS only). The severity of complications also correlated with RFS (P = 0 center dot 006) and overall survival (P = 0 center dot 001). Conclusion Postoperative complications were independently associated with decreased long-term survival after surgery for CLM with curative intent. The prevention and management of postoperative adverse events may be important oncologically.