Gooiker et al reported risk factors for excess mortality at 1-year following curative surgery for colorectal cancer. This can help to identify a patient who may benefit from more aggressive management. The authors are from Leiden University Medical Centre, Comprehensive Cancer Centre Leiden and HAGA Hospital The Hague in the Netherlands.

Patient selection: colorectal cancer following curative surgery (excludes Stage IV)


Risk factors for excess mortality in a patient with colon cancer:

(1) emergency surgery (relative excess risk 3.3)

(2) Charlson comorbidity index >= 2 (relative excess risk 5.2

(3) stage III (relative excess risk 2.6)

(4) postoperative complications (relative excess risk 2.1)


Risk factors for excess mortality in a patient with rectal cancer:

(1) age >= 75 years (relative excess risk 7.0)

(2) Charlson comorbidity index >= 1 (see Figure 2)

(3) stage II or III (see Figure 2)

(4) postoperative complications (relative excess risk 5.9)



Postoperative adverse events include surgical site infections, abdominal wall problems, bleeding, anastomotic leak, cardiac problems, pneumonia, and thromboemboli. The authors used a prolonged length of stay (>= 15 days after surgery) as a substitute for overall complications.

The Charlson comorbidity score probably is after excluding malignancy since this conveys 2 points, making a value of 0 or 1 impossible.

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