Risk factors for excess mortality in the first year after curative surgery for colorectal cancer - PubMed (original) (raw)

Risk factors for excess mortality in the first year after curative surgery for colorectal cancer

Gea A Gooiker et al. Ann Surg Oncol. 2012 Aug.

Abstract

Background: Thirty-day mortality after surgery for colorectal cancer may vastly underestimate 1-year mortality. This study aimed to quantify the excess mortality in the first postoperative year of stage I-III colorectal cancer patients and to identify risk factors for excess mortality.

Methods: All 2,131 patients who were operated with curative intent for stage I-III colorectal cancer in the western region of the Netherlands between January 1, 2006, and December 31, 2008, were analyzed. Thirty-day mortality and relative survival were calculated. In addition, relative excess risk (RER) of death was estimated by a multivariable model.

Results: Thirty-day mortality was 4.9%. One-year mortality was 12.4%. Risk factors for excess mortality in the first postoperative year for colon cancer patients were emergency surgery (excess mortality 29.7%, RER 2.5, 95% confidence interval 2.5-5.0), a Charlson score of >1 (excess mortality 12.6%, RER 2.3, 95% confidence interval 1.5-3.7), stage II or III disease (excess mortality 14.9%, RER 3.9, 95% confidence interval 1.9-8.1), and postoperative adverse events (excess mortality 22.6%, RER 2.1, 95% confidence interval 1.4-3.2).

Conclusions: The 30-day mortality rate highly underestimates the risk of dying in the first year after surgery, with excess 1-year mortality rates varying from 15 to 30%. This excess mortality was especially prominent in patients with comorbidities, higher stages of disease, emergency surgery, and postoperative surgical complications.

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Figures

Fig. 1

Fig. 1

Relative survival in the first year. a All patients. b Colon cancer patients treated in an emergency setting. The horizontal dotted line marks day 30 day after surgery. The blue line indicates the relative survival in the first year. The space between the vertical dotted line and the blue line represents the excess mortality after 30 days and within the first year after surgery

Fig. 2

Fig. 2

Factors associated with 1-year relative survival in multivariable analysis for colon and rectal cancer patients. At the y axis, the effect size is represented as adjusted relative excess risk (RER) for 1-year mortality, compared to the reference group, which always has a RER of 1

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