Safety of elective colorectal cancer surgery: Non-surgical complications and colectomies are targets for quality improvement

Daniel Henneman, Martijn G. Ten Berge, Heleen S. Snijders, Nicoline J. Van Leersum, Marta Fiocco, Theo Wiggers, Rob A.E.M. Tollenaar, Michel W.J.M. Wouters

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32 Citations (Scopus)


Background Mortality following severe complications (failure-to-rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon- and rectal cancer resections. Methods Analysis of patients undergoing elective colon and rectal cancer resections registered in the Dutch Surgical Colorectal Audit in 2011-2012. Severe complication- and FTR rates were compared between the groups in univariate and multivariate analysis. Results Colon cancer (CC) patients (n = 10,184) were older and had more comorbidity. Rectal cancer (RC) patients (n = 4,906) less often received an anastomosis and had more diverting stomas. Complication rates were higher in RC patients (24.8% vs. 18.3%, P < 0.001). However, FTR rates were higher in CC patients (18.6% vs. 9.4%, P < 0.001). Particularly, FTR associated with anastomotic leakage, postoperative bleeding, and infections was higher in CC patients. Adjusted for casemix, CC patients had a twofold risk of FTR compared to RC patients (OR 1.89, 95% CI 1.06-3.37). Conclusions Severe complication rates were lower in CC patients than in RC patients; however, the risk of dying following a severe complication was twice as high in CC patients, regardless of differences in characteristics between the groups. Efforts should be made to improve recognition and management of postoperative (non-)surgical complications, especially in colon cancer surgery.

Original languageEnglish
Pages (from-to)567-573
Number of pages7
JournalJournal of Surgical Oncology
Issue number6
Publication statusPublished - May 2014
Externally publishedYes


  • colon cancer
  • failure to rescue
  • postoperative complications
  • postoperative mortality
  • rectal cancer


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