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Influence of Comorbidity and Age on 1-, 2-, and 3-Month Postoperative Mortality Rates in Gastrointestinal Cancer Patients

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 07 November 2012

Abstract

Background

Studies on the impact of comorbidity and age on postoperative outcome after gastrointestinal tumor resection are scarce. In this study we investigated the impact of comorbidity and age on 30-, 60-, and 90-day mortality after resection of esophageal, gastric, periampullary, colon, and rectal cancer.

Methods

The study included 8,583 patients recorded in the population-based Netherlands Cancer Registry, regions Eindhoven (Eindhoven Cancer Registry) and Mid and South Limburg, who underwent resection for cancer stage I–III. Patients were diagnosed between 2005 and 2010. Age was categorized as <65, 65–74, and ≥75 years.

Results

Comorbidity was present in more than two-thirds (n = 5,910) of patients. The 30-day mortality rates ranged from 0.5 % for rectal cancer patients <65 years to 12.8 % for gastric cancer patients ≥75 years. Patients with comorbidity who underwent esophageal tumor resection had the highest mortality rates, ranging from 8.4 % for 30-day to 12.0 % for 90-day mortality, while rectal cancer patients had the lowest rates, that is, 4.3–6.4 %, respectively. In multivariable analyses, cardiac disease (odds ratio [OR] = 1.74, 95 % confidence interval [95 % CI] = 1.32–2.30), vascular disease (OR = 1.41, 95 % CI = 1.02–1.95) and previous malignancies (OR = 1.38, 95 % CI = 1.02–1.86) in colon cancer, and cardiac disease (OR = 1.81, 95 % CI = 1.10–2.98) and vascular disease (OR = 1.95, 95 % CI = 1.11–3.42) in rectal cancer were associated with the highest 30-day mortality.

Conclusions

Postoperative mortality extends beyond 30 days. Comorbidity and older age are associated with early postoperative mortality after gastrointestinal cancer resection. Underlying comorbidity should be identified preoperatively with attention to patients’ specific needs to optimally attenuate risk prior to surgery. A less aggressive treatment approach may well be considered in these groups.

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Acknowledgment

The authors thank the Netherland Cancer Registry and registration personnel for their dedicated data collection. The authors also thank the hospitals located in the Eindhoven Cancer Registry area and in the Comprehensive Cancer Center the Netherlands, location Maastricht area: Amphia Hospital, Breda; Atrium Medical Center Parkstad, Brunssum, Heerlen, Kerkrade; Bernhoven Hospital, Veghel and Oss; Catharina Hospital, Eindhoven; Elkerliek Hospital, Helmond; Jeroen Bosch Hospital, ‘s-Hertogenbosch; Laurentius Hospital, Roermond; Maxima Medical Center, Eindhoven and Veldhoven; Orbis Medical Center, Geleen, Sittard; St. Anna Hospital, Geldrop; St. Jans Hospital, Weert; St. Elizabeth Hospital, Tilburg; TweeSteden Hospital, Tilburg and Waalwijk; University Hospital Maastricht, Maastricht; VieCuri Medical Center, Venlo and Venray.

Conflict of interest

There are no commercial interests to declare.

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Authors and Affiliations

  1. Eindhoven Cancer Registry, Comprehensive Cancer Center South (CCCS), Eindhoven, The Netherlands

    Yvette R. B. M. van Gestel PhD & Valery E. P. P. Lemmens PhD

  2. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands

    Valery E. P. P. Lemmens PhD

  3. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    Ignace H. J. T. de Hingh MD, PhD, Harm J. T. Rutten MD, PhD & Grard A. P. Nieuwenhuijzen MD, PhD

  4. Comprehensive Cancer Center the Netherlands (CCCNL), Utrecht, The Netherlands

    Jessie Steevens PhD

  5. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    Ronald M. van Dam MD, PhD

  6. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands

    Peter D. Siersema MD, PhD

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  1. Yvette R. B. M. van Gestel PhD
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  2. Valery E. P. P. Lemmens PhD
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Correspondence to Yvette R. B. M. van Gestel PhD.

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van Gestel, Y.R.B.M., Lemmens, V.E.P.P., de Hingh, I.H.J.T. et al. Influence of Comorbidity and Age on 1-, 2-, and 3-Month Postoperative Mortality Rates in Gastrointestinal Cancer Patients. Ann Surg Oncol 20, 371–380 (2013). https://doi.org/10.1245/s10434-012-2663-1

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  • DOI: https://doi.org/10.1245/s10434-012-2663-1

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