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Time trends in colorectal cancer early postoperative mortality. A French 25-year population-based study

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Postoperative mortality after resection of colorectal cancer is an important issue. The aim of this study was to assess early postoperative mortality in a well-defined French population.

Methods

Data on 30- and 90-day postoperative mortality after resection for colorectal cancer were extracted from the digestive cancer registry of Burgundy. Time trends of postoperative mortality between 1989 and 2013 were described for the large population. 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, using conditional logistic regressions.

Results

Among the 11,448 concerned patients, 30- and 90-day postoperative mortalities were 4.9 and 7.2%. Thirty-day operative mortality decreased 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). Diagnosis before 1997, male gender, advanced age, emergency surgery and palliative resection were associated with a significantly higher 30- and 90-day mortality rate. The univariate risk of mortality was two to three times higher for conventional open laparotomy and conversion than for laparoscopy-assisted surgery. The surgical approach was no longer significant in multivariate analysis. Emergency surgery and comorbidities were associated with higher 30- and 90-day postoperative mortality, whereas obesity was not specific.

Conclusion

Postoperative mortality after colorectal resection decreased over time. Surgical approach had no influence on early mortality. Improvement in the management of the elderly and patients with comorbidities is a challenge to reduce postoperative mortality in the future.

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Acknowledgments

The authors thank all the private and public physicians, specialists and pathologists for their collaboration and the French Public Health Institute (SpF) and the National Cancer Institute (INCa) for supporting the Registry.

Funding

The Registry is supported by the French Public Health Institute (SpF) and the National Cancer Institute (INCa).

Author information

Authors and Affiliations

  1. Digestive Cancer Registry of Burgundy, F-21000, Dijon, France

    Sylvain Manfredi, Valérie Jooste, Caroline Gay, Jean Faivre, Antoine Drouillard & Anne-Marie Bouvier

  2. EPICAD INSERM LNC-UMR 1231, F-21000, Dijon, France

    Sylvain Manfredi, Valérie Jooste, Caroline Gay, Jean Faivre, Antoine Drouillard & Anne-Marie Bouvier

  3. University Bourgogne Franche-Comté, F-21000, Dijon, France

    Sylvain Manfredi, Valérie Jooste, Caroline Gay, Jean Faivre, Antoine Drouillard & Anne-Marie Bouvier

  4. Dijon University Hospital, F-21000, Dijon, France

    Sylvain Manfredi, Valérie Jooste, Caroline Gay, Jean Faivre, Antoine Drouillard & Anne-Marie Bouvier

Authors
  1. Sylvain Manfredi
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  2. Valérie Jooste
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  3. Caroline Gay
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  4. Jean Faivre
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  5. Antoine Drouillard
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  6. Anne-Marie Bouvier
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Contributions

SM was responsible for study coordination, acquisition of data, interpretation of data and manuscript writing. VJ was responsible for the statistical analysis and involved in the interpretation of data and drafting of the manuscript. CG was involved in the interpretation of data and manuscript writing. JF was involved in the interpretation of data and manuscript writing. AD was involved in the interpretation of data and critical revision of the manuscript. AMB was responsible for the acquisition of data and involved in study design and manuscript writing.

Corresponding author

Correspondence to Anne-Marie Bouvier.

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The authors declare that they have no conflicts of interest.

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Manfredi, S., Jooste, V., Gay, C. et al. Time trends in colorectal cancer early postoperative mortality. A French 25-year population-based study. Int J Colorectal Dis 32, 1725–1731 (2017). https://doi.org/10.1007/s00384-017-2918-1

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  • DOI: https://doi.org/10.1007/s00384-017-2918-1

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