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Early and Late Complications Among Long-Term Colorectal Cancer Survivors With Ostomy or Anastomosis

Liu, Liyan M.D., M.S.1; Herrinton, Lisa J. Ph.D.1; Hornbrook, Mark C. Ph.D.2; Wendel, Christopher S. M.S.3; Grant, Marcia D.N.Sc.4; Krouse, Robert S. M.D.3,5

Diseases of the Colon & Rectum: February 2010 - Volume 53 - Issue 2 - p 200-212
doi: 10.1007/DCR.0b013e3181bdc408
Original Contribution

PURPOSE: Among long-term (≥5 y) colorectal cancer survivors with permanent ostomy or anastomosis, we compared the incidence of medical and surgical complications and examined the relationship of complications with health-related quality of life.

BACKGROUND: The incidence and effects of complications on long-term health-related quality of life among colorectal cancer survivors are not adequately understood.

METHODS: Participants (284 survivors with ostomies and 395 survivors with anastomoses) were long-term colorectal cancer survivors enrolled in an integrated health plan. Health-related quality of life was assessed via mailed survey questionnaires from 2002 to 2005. Information on colorectal cancer, surgery, comorbidities, and complications was obtained from computerized data and analyzed by use of survival analysis and logistic regression.

RESULTS: Ostomy and anastomosis survivors were followed up for an average of 12.1 and 11.2 years, respectively. Within 30 days of surgery, 19% of ostomy survivors and 10% of anastomosis survivors experienced complications (P < .01). From 31 days on, the percentages were 69% and 67% (after adjustment, P < .001). Bleeding and postoperative infection were common early complications. Common long-term complications included hernia, urinary retention, hemorrhage, skin conditions, and intestinal obstruction. Ostomy was associated with long-term fistula (odds ratio, 5.4; 95% CI 1.4–21.2), and among ostomy survivors, fistula was associated with reduced health-related quality of life (P < .05).

CONCLUSIONS: Complication rates remain high despite recent advances in methods of surgical treatment. Survivors with ostomy have more complications early in their survivorship period, but complications among anastomosis survivors catch up after 20 years, when the 2 groups have convergent complication rates. Among colorectal cancer survivors with ostomy, fistula has especially important implications for health-related quality of life.

1 Division of Research, Kaiser Permanente, Oakland, California

2 The Center for Health Research, Northwest/Hawaii/Southeast, Kaiser Permanente Northwest, Portland, Oregon

3 Southern Arizona Veterans Affairs Health Care System, Tucson, Arizona

4 City of Hope National Medical Center/Beckman Research Institute, Duarte, California

5 University of Arizona College of Medicine, Tucson, Arizona

This work was performed by the SAVAHCS/Kaiser Permanente Collaborative Research Group and was supported by Grant R01 CA106912, HRQOL in Colorectal Cancer Survivors with Stomas, from the National Cancer Institute, National Institutes of Health, in collaboration with resources and the use of facilities provided at the Southern Arizona VA Health Care System, Tucson, AZ, and Kaiser Permanente.

Poster presentation at the meeting of the Society of Surgical Oncology, Phoenix, AZ, March 5 to 8, 2009.

Correspondence: Robert S. Krouse, M.D., F.A.C.S., Staff General and Oncologic Surgeon, Southern Arizona Veterans Affairs Health Care System, Surgical Care Line, 2-112, 3601 S. 6th Ave, Tucson, AZ 85723. E-mail:

© The ASCRS 2010