The Relationship Between Clavien–Dindo Morbidity Classification and Oncologic Outcomes After Colorectal Cancer Resection

Leonardo De Castro Duraes, Luca Stocchi, Scott R. Steele, Matthew F. Kalady, James M. Church, Emre Gorgun, David Liska, Hermann Kessler, Olga A. Lavryk, Conor P. Delaney

Research output: Contribution to journalArticle

Abstract

Background: Limited data on the relationship between postoperative complications (POCs) after colorectal cancer resection and oncologic outcomes are available. We hypothesized that the increased severity of POCs is associated with progressively worse oncologic outcomes. Methods: Patients with pathological stages I–III colorectal adenocarcinoma undergoing elective curative resection in a single institution between 2000 and 2012 were identified from a prospectively collected database. The severity of POCs was determined using the Clavien–Dindo classification, and oncologic outcomes were assessed. Results: Of 2266 patients, 669 (30%) had at least one POC. POCs were not associated with pathologic stage (p = 0.58) or use of adjuvant therapy (p = 0.19). With a mean follow-up of 5.3 years, POCs were associated with decreased 5-year overall survival (OS) (60% vs. 77%, p < 0.001), disease-free survival (DFS) (53% vs. 70%, p < 0.001), cancer-specific survival (CSS) (81% vs. 87%, p < 0.001), and increased overall recurrence rates (19% vs. 15%, p = 0.008). Increasing Clavien–Dindo scores from I to IV was significantly associated with progressively decreasing OS (71, 64, 60, 22%, p < 0.001), DFS (65, 58, 51, 19%, p < 0.001), CSS (88, 77, 79, 74%, p < 0.001), and increasing recurrence rates (12, 20, 26, 18%, p = 0.002). Multivariate analysis confirmed POCs as an independent factor associated with decreased OS [hazard ratio (HR) 0.63, 95% CI 0.52–0.76], DFS (HR 0.64, 95% CI 0.54–0.76), CSS (HR 0.73, 95% CI 0.56–0.97), and increased recurrence rates (HR 1.36, 95% CI 1.02–1.80). Conclusions: POCs are associated with adverse oncologic outcomes, with increasing effect with higher Clavien–Dindo score. Efforts to reduce both the incidence and severity of complications should result in improved oncologic outcomes.

Original languageEnglish (US)
Pages (from-to)188-196
Number of pages9
JournalAnnals of Surgical Oncology
Volume25
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Colorectal Neoplasms
Morbidity
Survival
Disease-Free Survival
Recurrence
Neoplasms
Adenocarcinoma
Multivariate Analysis
Databases
Incidence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

The Relationship Between Clavien–Dindo Morbidity Classification and Oncologic Outcomes After Colorectal Cancer Resection. / De Castro Duraes, Leonardo; Stocchi, Luca; Steele, Scott R.; Kalady, Matthew F.; Church, James M.; Gorgun, Emre; Liska, David; Kessler, Hermann; Lavryk, Olga A.; Delaney, Conor P.

In: Annals of Surgical Oncology, Vol. 25, No. 1, 01.01.2018, p. 188-196.

Research output: Contribution to journalArticle

De Castro Duraes, L, Stocchi, L, Steele, SR, Kalady, MF, Church, JM, Gorgun, E, Liska, D, Kessler, H, Lavryk, OA & Delaney, CP 2018, 'The Relationship Between Clavien–Dindo Morbidity Classification and Oncologic Outcomes After Colorectal Cancer Resection', Annals of Surgical Oncology, vol. 25, no. 1, pp. 188-196. https://doi.org/10.1245/s10434-017-6142-6
De Castro Duraes, Leonardo ; Stocchi, Luca ; Steele, Scott R. ; Kalady, Matthew F. ; Church, James M. ; Gorgun, Emre ; Liska, David ; Kessler, Hermann ; Lavryk, Olga A. ; Delaney, Conor P. / The Relationship Between Clavien–Dindo Morbidity Classification and Oncologic Outcomes After Colorectal Cancer Resection. In: Annals of Surgical Oncology. 2018 ; Vol. 25, No. 1. pp. 188-196.
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title = "The Relationship Between Clavien–Dindo Morbidity Classification and Oncologic Outcomes After Colorectal Cancer Resection",
abstract = "Background: Limited data on the relationship between postoperative complications (POCs) after colorectal cancer resection and oncologic outcomes are available. We hypothesized that the increased severity of POCs is associated with progressively worse oncologic outcomes. Methods: Patients with pathological stages I–III colorectal adenocarcinoma undergoing elective curative resection in a single institution between 2000 and 2012 were identified from a prospectively collected database. The severity of POCs was determined using the Clavien–Dindo classification, and oncologic outcomes were assessed. Results: Of 2266 patients, 669 (30{\%}) had at least one POC. POCs were not associated with pathologic stage (p = 0.58) or use of adjuvant therapy (p = 0.19). With a mean follow-up of 5.3 years, POCs were associated with decreased 5-year overall survival (OS) (60{\%} vs. 77{\%}, p < 0.001), disease-free survival (DFS) (53{\%} vs. 70{\%}, p < 0.001), cancer-specific survival (CSS) (81{\%} vs. 87{\%}, p < 0.001), and increased overall recurrence rates (19{\%} vs. 15{\%}, p = 0.008). Increasing Clavien–Dindo scores from I to IV was significantly associated with progressively decreasing OS (71, 64, 60, 22{\%}, p < 0.001), DFS (65, 58, 51, 19{\%}, p < 0.001), CSS (88, 77, 79, 74{\%}, p < 0.001), and increasing recurrence rates (12, 20, 26, 18{\%}, p = 0.002). Multivariate analysis confirmed POCs as an independent factor associated with decreased OS [hazard ratio (HR) 0.63, 95{\%} CI 0.52–0.76], DFS (HR 0.64, 95{\%} CI 0.54–0.76), CSS (HR 0.73, 95{\%} CI 0.56–0.97), and increased recurrence rates (HR 1.36, 95{\%} CI 1.02–1.80). Conclusions: POCs are associated with adverse oncologic outcomes, with increasing effect with higher Clavien–Dindo score. Efforts to reduce both the incidence and severity of complications should result in improved oncologic outcomes.",
author = "{De Castro Duraes}, Leonardo and Luca Stocchi and Steele, {Scott R.} and Kalady, {Matthew F.} and Church, {James M.} and Emre Gorgun and David Liska and Hermann Kessler and Lavryk, {Olga A.} and Delaney, {Conor P.}",
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T1 - The Relationship Between Clavien–Dindo Morbidity Classification and Oncologic Outcomes After Colorectal Cancer Resection

AU - De Castro Duraes, Leonardo

AU - Stocchi, Luca

AU - Steele, Scott R.

AU - Kalady, Matthew F.

AU - Church, James M.

AU - Gorgun, Emre

AU - Liska, David

AU - Kessler, Hermann

AU - Lavryk, Olga A.

AU - Delaney, Conor P.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Limited data on the relationship between postoperative complications (POCs) after colorectal cancer resection and oncologic outcomes are available. We hypothesized that the increased severity of POCs is associated with progressively worse oncologic outcomes. Methods: Patients with pathological stages I–III colorectal adenocarcinoma undergoing elective curative resection in a single institution between 2000 and 2012 were identified from a prospectively collected database. The severity of POCs was determined using the Clavien–Dindo classification, and oncologic outcomes were assessed. Results: Of 2266 patients, 669 (30%) had at least one POC. POCs were not associated with pathologic stage (p = 0.58) or use of adjuvant therapy (p = 0.19). With a mean follow-up of 5.3 years, POCs were associated with decreased 5-year overall survival (OS) (60% vs. 77%, p < 0.001), disease-free survival (DFS) (53% vs. 70%, p < 0.001), cancer-specific survival (CSS) (81% vs. 87%, p < 0.001), and increased overall recurrence rates (19% vs. 15%, p = 0.008). Increasing Clavien–Dindo scores from I to IV was significantly associated with progressively decreasing OS (71, 64, 60, 22%, p < 0.001), DFS (65, 58, 51, 19%, p < 0.001), CSS (88, 77, 79, 74%, p < 0.001), and increasing recurrence rates (12, 20, 26, 18%, p = 0.002). Multivariate analysis confirmed POCs as an independent factor associated with decreased OS [hazard ratio (HR) 0.63, 95% CI 0.52–0.76], DFS (HR 0.64, 95% CI 0.54–0.76), CSS (HR 0.73, 95% CI 0.56–0.97), and increased recurrence rates (HR 1.36, 95% CI 1.02–1.80). Conclusions: POCs are associated with adverse oncologic outcomes, with increasing effect with higher Clavien–Dindo score. Efforts to reduce both the incidence and severity of complications should result in improved oncologic outcomes.

AB - Background: Limited data on the relationship between postoperative complications (POCs) after colorectal cancer resection and oncologic outcomes are available. We hypothesized that the increased severity of POCs is associated with progressively worse oncologic outcomes. Methods: Patients with pathological stages I–III colorectal adenocarcinoma undergoing elective curative resection in a single institution between 2000 and 2012 were identified from a prospectively collected database. The severity of POCs was determined using the Clavien–Dindo classification, and oncologic outcomes were assessed. Results: Of 2266 patients, 669 (30%) had at least one POC. POCs were not associated with pathologic stage (p = 0.58) or use of adjuvant therapy (p = 0.19). With a mean follow-up of 5.3 years, POCs were associated with decreased 5-year overall survival (OS) (60% vs. 77%, p < 0.001), disease-free survival (DFS) (53% vs. 70%, p < 0.001), cancer-specific survival (CSS) (81% vs. 87%, p < 0.001), and increased overall recurrence rates (19% vs. 15%, p = 0.008). Increasing Clavien–Dindo scores from I to IV was significantly associated with progressively decreasing OS (71, 64, 60, 22%, p < 0.001), DFS (65, 58, 51, 19%, p < 0.001), CSS (88, 77, 79, 74%, p < 0.001), and increasing recurrence rates (12, 20, 26, 18%, p = 0.002). Multivariate analysis confirmed POCs as an independent factor associated with decreased OS [hazard ratio (HR) 0.63, 95% CI 0.52–0.76], DFS (HR 0.64, 95% CI 0.54–0.76), CSS (HR 0.73, 95% CI 0.56–0.97), and increased recurrence rates (HR 1.36, 95% CI 1.02–1.80). Conclusions: POCs are associated with adverse oncologic outcomes, with increasing effect with higher Clavien–Dindo score. Efforts to reduce both the incidence and severity of complications should result in improved oncologic outcomes.

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