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Impact of Postoperative Complications on Long-term Survival After Resection for Rectal Cancer

Mrak, Karl M.D., M.Sc.1; Eberl, Thomas M.D.1; Laske, Andreas M.D.1; Jagoditsch, Michael M.D.1; Fritz, Josef D.I.2; Tschmelitsch, Jörg M.D.1

Diseases of the Colon & Rectum: January 2013 - Volume 56 - Issue 1 - p 20–28
doi: 10.1097/DCR.0b013e31826f2672
Original Contribution: Colorectal/Anal Neoplasia

BACKGROUND: The relevance of type and severity of postoperative complications after curative resection for rectal cancer on survival and recurrence rates is a matter of controversy.

OBJECTIVE: The aim of this study was to investigate the impact of postoperative complications on long-term outcome after resection for rectal cancer.

DESIGN: This study is a retrospective analysis of prospectively collected data.

SETTINGS: The study was conducted at a university teaching hospital by a specialized colorectal team.

PATIENTS: Between January 1984 and October 2008, 811 patients with rectal cancer underwent curative resection. Patients who experienced postoperative complications were divided into a minor complication group (grades I and II) and a major complications group (grades III and IV) according to the Clavien classification.

MAIN OUTCOME MEASURES: The influence of several pathological and clinical factors, including complications in terms of overall and disease-free survival, was tested and compared in univariate and multivariate analyses.

RESULTS: Curative resection was performed in 811 patients; median age was 65 years. The Kaplan-Meier estimates (± SE) for 5- and 10-year overall cumulative survival were 70.3% ± 1.8% and 54.5% ± 2.4%; Kaplan-Meier estimates for 5- and 10-year disease-free survival were 64.0% ± 1.8% and 50.9% ± 2.3%. One hundred sixty-five patients (20.3%) had minor complications, and 103 patients (12.7%) had major complications. Twelve patients (1.48%) died within 30 days after surgery. There was no significant difference between patients with no complications, patients with minor complications, and patients with major complications in terms of overall (p = 0.41) or disease-free survival (p = 0.32).

LIMITATIONS: A possible limitation of our study is that the data represent a cohort study from a single center.

CONCLUSION: Following resection for rectal cancer, the severity of postoperative complications (minor or major) according to a standardized classification system does not demonstrate a statistically significant effect on either overall or disease-free survival.

1 Department of Surgery, Hospital of the Brothers of Mercy, St. Veit/Glan, Austria

2 Assign Data Management and Biostatistics GmbH, Innsbruck, Austria

Financial Disclosure: None reported.

Correspondence: Jörg Tschmelitsch, M.D., Department of Surgery, Hospital of the Brothers of Mercy, Spitalgasse 26, A-9300 St. Veit/Glan, Austria. E-mail:

© The ASCRS 2013