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Annals of Surgical Oncology

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01-03-2017 | Healthcare Policy and Outcomes

Postoperative Complications and Long-Term Survival After Complex Cancer Resection

Authors: Hari Nathan, MD, PhD, Huiying Yin, MS, Sandra L. Wong, MD, MS

Published in: Annals of Surgical Oncology | Issue 3/2017

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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Title: Postoperative Complications and Long-Term Survival After Complex Cancer Resection
Authors: Hari Nathan, MD, PhD
Huiying Yin, MS
Sandra L. Wong, MD, MS
Publication date: 01-03-2017
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 3/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-016-5569-5

At a glance: The STEP trials

Springer Medicine

Postoperative Complications and Long-Term Survival After Complex Cancer Resection

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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