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Long-term outcome and cancer incidence after lower extremity bypass surgery in patients with critical limb threatening ischemia

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Abstract

Purpose

The influence of cancer development on long-term outcome after lower extremity bypass surgery in patients with critical limb threatening ischemia was investigated.

Methods

Patient survival and cancer incidence were recorded for 21,082 patients with peripheral artery disease (PAD) stage III (n = 5631; 26.7%) and stage IV (n = 15,451; 73.3%) registered with the AOK health insurance company in Germany who underwent infrainguinal bypass surgery. All patients were preoperative and in their history cancer-free.

Results

After a median follow-up of 44 months, 25.6% of all patients developed cancer (Kaplan–Meier estimated), with no significant differences between patients with PAD stage III and IV (cancer incidence stage III 25.7%, stage IV 25.5%; p = 0.421). In the Cox regression analysis, male gender (HR 1.885; 95% CI 1.714–2.073, p < 0.001) and age over 70 years (HR 1.399; 95% CI 1.285–1.522, p < 0.001) were significant risk factors for the development of cancer. Survival was significantly lower in stage IV (23.4%) compared to stage III (44.5%) (HR 1.720; 95% CI 1.645–1.799, p < 0.001). Cancer was a significant risk factor for overall survival in PAD stage III patients (HR: 1.326; 95% CI 1.195–1.471, p < 0.001) but not in PAD stage IV (HR 0.976; 95% CI 0.919–1.037, p = 0.434).

Conclusion

Patients with PAD stage III have significantly better survival after infrainguinal bypass surgery compared to patients with stage IV. While cancer incidence was essential for survival in stage III, it was of no importance in stage IV.

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Authors and Affiliations

  1. Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany

    Polykarpos Michailidis & Dittmar Böckler

  2. Department of Vascular and Endovascular Surgery, University Hospital Frankfurt, Frankfurt, Germany

    Jasmin Epple

  3. Goethe University, Frankfurt, Germany

    Thomas Schmitz-Rixen

  4. German Institute for Vascular Healthcare Research (DIGG) of the German Society for Vascular Surgery and Vascular Medicine, Berlin, Germany

    Reinhart T. Grundmann

  5. Department of Vascular Medicine, University Heart and Vascular Center (UHC), University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Reinhart T. Grundmann

Authors
  1. Polykarpos Michailidis
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  2. Jasmin Epple
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  3. Dittmar Böckler
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  4. Thomas Schmitz-Rixen
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  5. Reinhart T. Grundmann
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on behalf of DIGG gGmbH

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by P. M., R. T. G., and J. E. The statistical analysis was performed by P. M. The first draft of the manuscript was written by R. T. G., J. E., and P. M., involving all authors. The final version of this paper was approved by all authors.

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Correspondence to Reinhart T. Grundmann.

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Michailidis, P., Epple, J., Böckler, D. et al. Long-term outcome and cancer incidence after lower extremity bypass surgery in patients with critical limb threatening ischemia. Langenbecks Arch Surg 408, 444 (2023). https://doi.org/10.1007/s00423-023-03125-7

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