Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

Jack Lawler, Michelle Choynowski, Katie Bailey, Magda Bucholc, Alison Johnston, Michael Sugrue

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33 Citations (Scopus)
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BACKGROUND: Cancer outcomes are complex, involving prevention, early detection and optimal multidisciplinary care. Postoperative infection and surgical site-infection (SSI) are not only uncomfortable for patients and costly, but may also be associated with poor oncological outcomes. A meta-analysis was undertaken to assess the oncological effects of SSI in patients with colorectal cancer. METHODS: An ethically approved PROSPERO-registered meta-analysis was conducted following PRISMA guidelines. PubMed and Scopus databases were searched for studies published between 2007 and 2017 reporting the effects of postoperative infective complications on oncological survival in colorectal cancer. Results were separated into those for SSI and those concerning anastomotic leakage. Articles with a Methodological Index for Non-Randomized Studies score of at least 18 were included. Hazard ratios (HRs) with 95 per cent confidence intervals were computed for risk factors using an observed to expected and variance fixed-effect model. RESULTS: Of 5027 articles were reviewed, 43 met the inclusion criteria, with a total of 154 981 patients. Infective complications had significant negative effects on overall survival (HR 1·37, 95 per cent c.i. 1·28 to 1·46) and cancer-specific survival (HR 2·58, 2·15 to 3·10). Anastomotic leakage occurred in 7·4 per cent and had a significant negative impact on disease-free survival (HR 1·14, 1·09 to 1·20), overall survival (HR 1·34, 1·28 to 1·39), cancer-specific survival (HR 1·43, 1·31 to 1·55), local recurrence (HR 1·18, 1·06 to 1·32) and overall recurrence (HR 1·46, 1·27 to 1·68). CONCLUSION: This meta-analysis identified a significant negative impact of postoperative infective complications on overall and cancer-specific survival in patients undergoing colorectal surgery.

Original languageEnglish
Pages (from-to)737-747
Number of pages11
JournalBritish Journal of Surgery
Issue number5
Early online date11 Jun 2020
Publication statusPublished (in print/issue) - 1 Oct 2020

Bibliographical note

Publisher Copyright:
© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.

This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine


  • colorectal cancer surgery
  • oncological outcome
  • oncology
  • cancer surgery
  • postoperative complications
  • meta-analysis
  • cancer outcome
  • surgical site-infection


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