Impact of Postoperative Infectious Complications on Long‐Term Survival After Curative Resection for Colorectal Cancer: A Multicenter Study in the Minimally Invasive Era
Takehito Yamamoto, Ryosuke Mizuno, Yoshiro Itatani, Tetsuya Shiota, Masahiro Yamada, Tadayoshi Yamaura, Mami Yoshitomi, Kazutaka ObamaABSTRACT
Aim
Previous studies have reported that postoperative infectious complications (PICs) worsen long‐term outcomes after colorectal cancer surgery; however, most were conducted before widespread adoption of minimally invasive surgery. We evaluated the association between PICs and long‐term oncological outcomes after curative colorectal cancer resection.
Methods
This multicenter, retrospective cohort study enrolled patients who underwent curative resection for colorectal adenocarcinoma between 2017 and 2021 at 19 hospitals in Japan. PICs were defined as Clavien‐Dindo grade≥II infectious complications within 30 days after surgery. Multivariable Cox regression and propensity score matching (1:4) were used to evaluate associations with overall survival (OS) and relapse‐free survival (RFS).
Results
Among 5377 patients, 90.6% underwent laparoscopic or robot‐assisted surgery, and PICs occurred in 500 (9.3%). In multivariable Cox proportional hazards analysis, PICs were independently associated with worse OS (HR 1.32, 95% CI 1.01–1.72; p = 0.040) and RFS (HR 1.26, 95% CI 1.04–1.54; p = 0.020). After propensity score matching (500 vs. 1931 patients), PICs remained significantly associated with poorer OS and RFS. Patients with PICs had a higher rate of distant recurrence (5‐year rate, 19.1% vs. 15.2%; HR 1.33, 95% CI 1.02–1.72; p = 0.03), whereas locoregional recurrence did not differ significantly.
Conclusion
PICs are associated with impaired long‐term survival after curative colorectal cancer surgery, even in the modern minimally invasive era. Preventing postoperative infections is important to improve perioperative recovery and long‐term oncological outcomes.