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

Nari Shin; Eon Chul Han; Sungho Won; Seung-Bum Ryoo; Eun Kyung Choe; Byung Kwan Park; Kyu Joo Park

doi: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

Ann Surg Treat Res. 2020 Aug;99(2):82-89. doi: 10.4174/astr.2020.99.2.82. Epub 2020 Jul 31.

Authors

Nari Shin¹, Eon Chul Han², Sungho Won^{1

3}, Seung-Bum Ryoo⁴, Eun Kyung Choe⁵, Byung Kwan Park⁶, Kyu Joo Park⁴

Affiliations

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

Keywords: Colorectal neoplasms; Complication; Liver cirrhosis; Oncological results.