The Impact of Postoperative Complications After Colon Cancer Surgery on Locoregional Recurrence: A Population-Based Dutch Cohort Study
BACKGROUND: In contrast to rectal cancer, the influence of postoperative complications on locoregional recurrence (LRR) in colon cancer is understudied, with conflicting reports. This study aimed to determine the impact of postoperative complications on LRR and overall survival (OS) in colon cancer. METHODS: This population-based cross-sectional cohort study was carried out in 50 Dutch hospitals. Patients who underwent resection for stage I-III colon cancer between January 2014 and December 2015 were eligible. LRR comprised any intraabdominal recurrence, including peritoneal metastases. RESULTS: A total of 7983 patients were included with a median follow-up of 62.5 months (interquartile range 58.1-80.3). Postoperative complications occurred in 2239 (28.0%) patients and included anastomotic leakage requiring re-intervention in 394 (4.9%), any other surgical complication in 944 (11.8%), and only non-surgical complications in 901 patients (11.3%). The 5-year LRR rate was 13.5%, 8.8% and 8.8%, respectively, as compared with 6.8% in patients without complications (Fine-Gray p<0.001). Only anastomotic leakage was an independent risk factor for LRR (cause-specific hazard ratio [HR] 1.45 [95% confidence interval (CI) 1.07-1.96]). Five-year OS probability was 78.9% for patients without complications versus 71.1%, 68.5%, and 62.7% for patients with anastomotic leakage, any other surgical complication, and non-surgical complications only, respectively (log-rank p<0.001). Both surgical and non-surgical complications were an independent risk factor for worse OS (HR 1.12 [95% CI 1.00-1.26); HR 1.21 [95% CI 1.08-1.36], respectively). DISCUSSION: This study demonstrates an increased risk of LRR after all types of postoperative complications in patients with stage I-III colon cancer, but only anastomotic leakage remained independently associated with LRR. Both surgical and non-surgical complications were associated with worse OS.
Authors
- Eva Rademaker (ORCID: https://orcid.org/0000-0002-9083-2550)
- A. Demirkiran
- Jan Willem T. Dekker (ORCID: https://orcid.org/0000-0002-3429-468X)
- V.P. Bastiaenen
- O. Kranenburg
- WAA Borstlap
- C.A. Gispen
- I. Kappers
- M Kusters (ORCID: https://orcid.org/0000-0002-9535-5546)
- Niels F M Kok
- E. Ancion
- AHC Gielen
- F. Heilijgers
- J. L. M. Konsten
- H. T. J. Mantel
- EG Boerma
- K. Havenga
- J. W. A. Leijtens
- H. J. Belgers
- J. Melenhorst
- D. M. Mens
- W. M. U. Grevenstein
- B.A. Grotenhuis
- J. Nonner
- A.C.H.M. Jongen
- T.B.M. Van den Heuvel
- S.A. Dingemans
- L.A. Brugts
- T.A. Burghgraef
- D.P.V. Lambrichts
- E.Z. Barsom
- I. Hochstenbach
- A.G. Den Hartog
- R.J.S. Coelen
- R.H.A. Berndsen
- R.T.J. Geitenbeek
- M.J.P.M. Govaert
- E.W. Lockhorst
- P. Krielen
- M.M. Kieboom
- J.D.W. Van der Bilt
- B. Lamme
- J.A.G. Van der Heijden
- A. Kumas
- N. Koemans
- S. Karhof
- F.J. Amelung
- A.J. Eleveld
- S. Dijkink
- B.A.J. Kertzman
- M. Cleveringa
- L.C.F. De Nes
- V.M. Belvroy
- M.J.H. Metman
- A.A.J. Grüter
- H.A. Galema
- I. Aanen
- H. Lutfi
- V.P. Groot
- J. W. A. Burger
- J. C. Hol
- M. A. J. Becker
- S. F. Hardon
- D. C. Van der Aa
- S. Malm
- J. Van Hilst
- W. H. Kopp
- P. Meijer
- Esther C. J. Consten
- L. Van Dullemen
- S. M. M. De Castro
- L. R. Moolenaar
- C. Hoff
- S. M. Van Aalten
- G. L. Van Leeuwen
- B. Biersteker
- E. B. Van Duyn
- Jurriaan B. Tuynman
- Rudolf van den Berg
- P. Van Amstel
- S. Bluiminck
- V. Baart
- F. C. Den Boer
- M. C. Boonstra
- G. A. Martini
- R. S. Hijmans
- Henderik L. Van Westreenen
- Pieter J. Tanis
- S. Janki
- T. Bazuin
- E. Dijkema
- E. G. M. Van Geffen
- J. A. Nieuwstraten
- Bade C. Aktas
- A. A. W. Van Geloven
- J. G. Bloemen
- Johannes H. W. de Wilt
- Ignace H. J. T. de Hingh
- J. J. Atema
- T. S. Aukema
Institutions
- University Medical Center Groningen (NL)
- Radboud University Nijmegen (NL)
- Catharina Ziekenhuis (NL)
- Radboud University Medical Center (NL)
- The Netherlands Cancer Institute (NL)
- Reinier de Graaf Hospital (NL)
- Isala (NL)
- Erasmus MC Cancer Institute (NL)
- Amsterdam University Medical Centers (NL)
- Meander Medisch Centrum (NL)
- University of Amsterdam (NL)
Publication Details
- Journal
- Annals of Surgical Oncology
- Published
- 2026-04-22
- DOI
- https://doi.org/10.1245/s10434-026-19637-7
- Primary Topic
- Colorectal Cancer Surgical Treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- KWF Kankerbestrijding