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

Autor: Gooiker GA; Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands., Dekker JW, Bastiaannet E, van der Geest LG, Merkus JW, van de Velde CJ, Tollenaar RA, Liefers GJ
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2012 Aug; Vol. 19 (8), pp. 2428-34. Date of Electronic Publication: 2012 Mar 07.
DOI: 10.1245/s10434-012-2294-6
Abstrakt: 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.
Databáze: MEDLINE
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