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Postoperative Complications and Long-Term Survival After Complex Cancer Resection

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recent attention has focused on the ability to rescue patients from postoperative complications and prevent short-term mortality. However, it is unknown whether patients rescued from complications after complex cancer resections have long-term survival outcomes similar to those of patients without complications.

Methods

From 2005 to 2009 Surveillance, Epidemiology, and End Results (SEER)-Medicare data, the study identified elderly patients who underwent resection for cancers of the esophagus, lung, or pancreas. The association of risk-adjusted long-term survival with serious complications, minor complications, and no complications was analyzed.

Results

The study included 905 patients with esophageal cancer, 12,395 patients with lung cancer, and 1966 patients with pancreatic cancer. The serious complication rates were respectively 17.4, 9.5 and 11.8 %. The patients with serious complications had lower 5-year survival rates than those with no complications even if they were rescued and survived 30 days (20 vs 43 % for esophagus, 29 vs 54 % for lung, and 10 vs 21 % for pancreas cancer). Even after patients who died within 180 days after surgery were excluded from the analysis, a decrement in risk-adjusted long-term survival was observed among the patients with serious complications after all three procedures. The association between complications and long-term survival was not explained by differences in receipt of adjuvant chemotherapy

Conclusion

Patients who undergo complex cancer resection and experience serious complications have diminished long-term survival, even if they are “rescued” from their complications. This finding persists even when deaths within 6 months after surgery are excluded from the analysis. Metrics of surgical success should consider terms beyond 30 and even 90 days as well as the long-term consequences of surgical complications.

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Disclosure

Dr. Sandra L. Wong was supported by AHRQ1K08 HS20937-01 and American Cancer Society RSG-12-269-01-CPHPS.

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Authors and Affiliations

  1. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Hari Nathan MD, PhD & Huiying Yin MS

  2. Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Sandra L. Wong MD, MS

Authors
  1. Hari Nathan MD, PhD
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  2. Huiying Yin MS
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  3. Sandra L. Wong MD, MS
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Correspondence to Hari Nathan MD, PhD.

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Nathan, H., Yin, H. & Wong, S.L. Postoperative Complications and Long-Term Survival After Complex Cancer Resection. Ann Surg Oncol 24, 638–644 (2017). https://doi.org/10.1245/s10434-016-5569-5

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  • DOI: https://doi.org/10.1245/s10434-016-5569-5

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