Manfredi S, et al. - This study was performed with the goal to determine colorectal cancer early postoperative mortality in a well-defined French population. Observations revealed a decrease in postoperative mortality after colorectal resection over time. There appeared no influence of surgical approach on early mortality. To reduce postoperative mortality, improvement in the management of the elderly and patients with comorbidities seemed a challenge.

Methods

• Researchers extracted data on 30- and 90-day postoperative mortality after resection for colorectal cancer from the digestive cancer registry of Burgundy.
• They described time trends of postoperative mortality between 1989 and 2013 for the large population.
• Using conditional logistic regressions, case-control studies (death within 30 or 90 days = cases, alive at 90 days = controls) focused on the association between postoperative mortality and surgical approach, obesity and other comorbidities over the last [2010–2013] period.

Results

• 11,448 patients were included; 30- and 90-day postoperative mortalities were 4.9 and 7.2%.
• A decrease in thirty-day operative mortality was evident from 7.2% (1989–1993) to 4.4% (2010–2013; p < 0.001) for colon cancer and from 4.2 to 3.3% for rectal cancer (NS).
• Significantly higher 30- and 90-day mortality rates were observed with diagnosis before 1997, male gender, advanced age, emergency surgery and palliative resection.
• For conventional open laparotomy and conversion, the univariate risk of mortality was two to three times higher than for laparoscopy-assisted surgery.
• In multivariate analysis, the surgical approach was no longer significant.
• There appeared an association of emergency surgery and comorbidities with higher 30- and 90-day postoperative mortality, whereas obesity was not specific.