Ann Surg Treat Res.  2020 Aug;99(2):82-89. 10.4174/astr.2020.99.2.82.

The prognoses and postoperative outcomes of patients with both colorectal cancer and liver cirrhosis based on a nationwide cohort in Korea

Affiliations
  • 1Department of Public Health Sciences and Institute of Health and Environment, Seoul National University, Seoul, Korea
  • 2Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
  • 3Interdisciplinary Program in Bioinformatics, Seoul National University, Seoul, Korea
  • 4Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 5Department of Surgery, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
  • 6Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea

Abstract

Purpose
The management of patients with colorectal cancer (CRC) who have liver cirrhosis (LC) requires a thorough understanding of both diseases; however, the prognoses and postoperative outcomes of such patients remain understudied. We investigated the effect of LC on surgical and oncologic outcomes in patients with CRC, and identified prognostic factors.
Methods
We analyzed 453 patients with CRC and LC (CRC-LC group), 906 with CRC only (CRC group), 906 with LC only (LC group), and 1,812 healthy subjects using health insurance claim data (2008–2013).
Results
The CRC-LC group had a higher frequency of intensive care unit admission than the CRC group; there were no differences between the 2 groups in terms of early and late postoperative small bowel obstruction and incisional hernia. However, the 30-day, 60-day, and 90-day mortality rates were all significantly higher in the CRC-LC group. The higher Charlson comorbidity index (hazard ratio [HR], 1.127) and the lower socioeconomic status (HR, 0.985) were significant worse predictors of 5-year survival. Patients with underlying LC had a significantly higher HR in both the advanced CRC (HR, 1.858) and nonadvanced CRC (HR, 1.799) subgroups. However, the nonadvanced CRC subgroup showed a lower HR than the LC group (HR, 0.730).
Conclusion
Patients with CRC who had underlying LC had a lower survival rate than did those without LC, although the incidence rates of postoperative complications were not significantly different. The presence of LC was associated with a significantly lower survival rate regardless of CRC presence.

Keyword

Colorectal neoplasms; Complication; Liver cirrhosis; Oncological results
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