THE IMPACT OF POST-SURGICAL COMPLICATIONS ON LONG TERM ONCOLOGICAL OUTCOMES FOLLOWING CURATIVE RESECTION OF COLORECTAL CANCER (STAGE I-III). A SYSTEMATIC REVIEW AND META-ANALYSIS.
Noor Mualla1, Maryam R Hussain*1, Muhammad Akrmah2
1Graduate School, Icahn School of Medicine at Mount Sinai, New York, NY; 2Hartford Hospital/University of Connecticut Health Center, Hartford, CT
Objective:
The aim of this systematic review and meta-analysis is to study the effect of post-operative complications on long term oncological outcomes following curative resection of only non-metastatic (Stage I-III) colorectal cancer.
Background and Introduction:
The incidence of post-surgical complications (PSC) after curative resection of non-metastatic colorectal cancer is fairly evident. Some studies suggest that post-surgical outcomes often predict poor long-term oncological outcomes. However, the available data is often controversial.
Methodology:
A comprehensive search of Medline and EMBASE was performed via Ovid, using controlled vocabulary as well as natural language terms for postoperative complications, outcomes and colorectal cancer. Two authors independently screened studies and extracted data. Conflicts were resolved by discussion among authors and independently with the help of a third author. Meta-analysis was performed using the random-effects model to calculate pooled estimates for overall survival, disease-free survival, and overall recurrence.
Results:
Overall, 3738 initially screened studies returned 16 retrospective studies, including 37,192 patients for final inclusion in the analysis. Pooled analysis of these studies showed that post-surgical complications predicted worse overall survival [HR of 1.43 (95% CI, 1.28-1.60; P< 0.00001)], disease-free survival [HR of 1.46 (95% CI, 1.18-1.79; P< 0.00001)] and overall recurrence [HR of 1.19 (95% CI, 1.04-1.37; P= 0.01)]. The impact of PSC will be further analyzed in subgroups such as type and severity of complications.
Conclusion:
Our findings suggest that post-surgical complications predict poor overall survival, disease-free survival, and recurrence following curative resection of non-metastatic colorectal cancer.
Figure 1: Forest plot of comparison: Complications vs No-complications, outcome: Overall Survival.
Figure 2: Forest plot of comparison: Complications vs No-complications, outcome: Disease-Free Survival.
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