Impact of Postoperative Complications On Oncologic Outcomes
Postoperative complications carry implications for short-term quality of life and negatively affect the cost of care. In addition, there is evidence that postoperative complications are associated with worse long-term, oncologic outcomes. While the exact mechanism of the impact on long-term survival is unclear, one factor is that postoperative complications result in delays in receiving and, in some cases, result in complete omission of chemotherapy after surgery. Hendren and colleagues used the SEER-Medicare database from 1993-2005 and examined risk for chemotherapy omission. They found that patients who suffered postoperative complications were more likely to have chemotherapy omitted or delayed. Tevis and colleagues looked at this question in patients undergoing surgery for rectal cancer. They found that patients with postoperative complications had worse long-term survival than did those patients with no complications. Using a multivariable analysis, postoperative complications correlated with decreased overall survival in patients who received chemotherapy. These results suggest that in addition to omission of chemotherapy, complications may have other negative effects leading to decreased long-term survival. Theories include immunosuppression caused by the prolonged recovery and debility after surgery with complications, as well as a changed microenvironment for tumor recurrence where there is a leak or infection.
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