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

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.