Comparing survival and recurrence in curative stage I to III colorectal cancer in transfused and nontransfused patients.

Evidence of the association between blood transfusions and its impact on prognostic outcomes in patients who undergo curative resection of colorectal cancer remains controversial. The aim of this study was to determine whether receiving peri-operative blood transfusions during curative colorectal cancer resection affected overall survival, cancer-related survival, and cancer recurrence. This retrospective study was undertaken at The Royal Brisbane and Women's Hospital, Australia, between 1984 and 2004. The outcomes of 1370 patients undergoing curative colorectal cancer resection for TNM stage I to III were analyzed. Four hundred twenty three patients (30.9%) required transfusion and 947 patients (69.1%) did not. Peri-operative transfusion was associated with higher rates of cancer recurrence on multivariate analysis (P = 0.024, RR, 1.257, 95% CI, 1.03-1.53); however, it was not independently associated with poorer overall or cancer-related survival. Where the aim is curative resection, this study contributes to a body of evidence that blood transfusions may be associated with poorer outcomes.

Predictors of postoperative mortality, morbidity, and long-term survival after palliative resection in patients with colorectal cancer.

BACKGROUND: Limited information is available on predictors of postoperative mortality, morbidity, and long-term survival in patients with stage IV colorectal cancer. OBJECTIVE: This study aimed to identify independent predictors of postoperative mortality and morbidity as well as independent predictors of long-term survival. DESIGN: This study was planned as a retrospective single-institution review. SETTING: This study took place at the Department of Surgery, The Royal Brisbane and Women's Hospital, Australia, between 1984 and 2004. PARTICIPANTS: Prospectively collected data were extracted from the records of 1867 patients undergoing treatment for colorectal cancer. The outcomes for 379 patients undergoing surgical resection of their primary colon or rectal tumor in the presence of unresectable synchronous metastases were analyzed. MAIN OUTCOME MEASURES: Independent predictive factors for postoperative mortality and morbidity as well as long-term survival were assessed by use of logistic regression and Cox regression analysis. RESULTS: Thirty-five (9.2%) patients died in the postoperative period and morbidity was 48.3%. Median survival was 11 months. Thirty-day postoperative mortality was independently associated with medical complications (P < .001), emergency operations (P = .001), female sex (P = .002), and age (≥ 70; P = .007) on regression analysis. Elderly (≥ 70) patients with either advanced local disease or extrahepatic metastases were at a particularly high risk. Preoperative predictors of surgical morbidity included male sex (P = .028) and advanced local disease (P = .036). Preoperative predictors of medical complications included repeat operations (P < .001), elevated urea levels (P = .017), and emergency operations (P = .003). Independent factors associated with poor overall survival included medical complications (P < .001), nodal stage (N2) (P = .004), poor tumor differentiation (P = .006), and apical lymph node involvement (P = .042). A subgroup of patients with advanced nodal disease (N2) and a poor tumor differentiation had a significantly poorer prognosis. LIMITATIONS: This study was limited by its retrospective nature. CONCLUSION: Elderly patients with advanced local disease or extrahepatic metastases are at high risk of 30-day postoperative mortality. Significant nodal disease and poor tumor differentiation are important predictors of long-term survival.

Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients.

BACKGROUND: Anastomotic leakage is associated with high mortality, high reoperation rate, and increased hospital length of stay. Although many studies have examined the risk factors for anastomotic leak, large prospective series that report on long-term survival rates are lacking. METHODS: Data of 1576 patients who underwent primary resection and anastomosis for colorectal adenocarcinoma at a single institution from 1984 to 2004 were prospectively collected. Anastomotic leaks (LEK) were classified as radiological (RAD), local (LOC), or generalised (GEN). Logistic regression analysis of 21 variables was undertaken. Overall survival, cancer-related survival, and disease-free survival were analysed using the Kaplan-Meier method. RESULTS: Mean age of the patients was 67 years (SD = 12.5) and 834 (52.9%) were male. An LEK was more likely when relatively major gynaecological (tubo-oophorectomy, P = 0.004; hysterectomy, P = 0.006) or urological (total cystectomy, P = 0.014) procedures were performed during the same operative session. Other significant factors were anterior resection (P < 0.001), anastomosis using an intraluminal stapling device (P = 0.005), abdominal drain via laparoscopic port (P = 0.024), postoperative blood transfusion (P < 0.001), primary cancer site at the rectum (P = 0.016), and TNM stage of T2 or higher (P = 0.026). Having an LEK showed significant impact on overall (P = 0.021), cancer-related (P = 0.006), and disease-free (P = 0.001) survival. CONCLUSION: In this prospective study, advanced tumour stage, distal site, and need for postoperative blood transfusion were associated with increased rates of anastomotic leakage. In addition to their high risk of immediate postoperative morbidity and mortality, both localized and generalized leaks had similarly negative impacts on overall, cancer-related, and disease-free survival.

The effect of obstruction and perforation on colorectal cancer disease-free survival.

BACKGROUND: Obstruction (OBSTR) and perforation (PERF) in colorectal cancer impact adversely upon outcomes, and cancer-related survival may also be affected. However, data are sparse, particularly on disease-free survival (DFS) where the cancer is both obstructed and perforated (OBS-PERF). METHODS: Data were extracted from a prospectively collected database of 1876 colorectal cancer patients managed and followed up at the Royal Brisbane Hospital from 1984 to 2004. The patients who had curative surgery (n = 1426) were classified as OBSTR (n = 153), PERF (n = 53), OBS-PERF (n = 19), and uncomplicated (UNCOM; n = 1201). Kaplan-Meier survival and Cox proportional hazard analyses were performed. RESULTS: Postoperative mortality within 30 days of surgery was 1.5% (n = 22) and the overall complication rate was 40.8% (n = 582). However, only 7.2% (n = 102) required reoperations. The median survival time was 71 (IQR = 64.9-77.1) months and the median follow-up for DFS was 37.5 (IQR 14-68) months. The overall recurrence rate was 32.7% (n = 466), the local recurrence rate was 9.4% (n = 135), and local and distant recurrences occurred in the same patient in 4.7% (n = 67). Male gender, OBSTR, PERF, OBS-PERF, emergency operation, major medical and surgical complications, reoperation, TNM staging, tumor grading, and tumor venous invasion adversely affected DFS (p < 0.05). Multivariate analysis showed that OBS-PERF (p = 0.008), major medical complications (p = 0.011), reoperation (p = 0.018), TNM staging (p < 0.001), grading (p = 0.018), and venous invasion (p = 0.002) were independently associated with a poorer DFS. CONCLUSIONS: OBS-PERF colorectal cancer is associated with a poorer DFS, which may be worse than either OBSTR or PERF alone.