Analysis Of Surgical Outcome In Patients With Colorectal Cancer And Chronic Obstructive Pulmonary Disease

BACKGROUNDColorectal Cancer(CRC)is one of the most common malignant tumors and the second leading cause of cancer-related death in the world.Chronic obstructive pulmonary disease(COPD)is also one of the most common chronic diseases in the world,with a high rate of disability and mortality.Some relevant studies have shown that COPD has an influence in intestinal function and promote the occurrence of colorectal precancerosis.Currently,surgery is the most effective treatment for CRC,but elderly CRC patients with COPD often have various degrees of lung function limitation,which leads to a decreased tolerance of surgery and an increased incidence of postoperative complications.Therefore,surgical treatment and perioperative management of CRC patients with COPD often bring some certain challenges to clinicians,and it requires a comprehensively consideration of the surgical benefits and risks to make clinical decisions.In addition,reports on the perioperative prognosis and overall survival of CRC patients with or without COPD in several research were incompletely the same.This study systematically reviewed the existing relevant literature and retrospectively analyzed the clinical data of patients with CRC surgery in our hospital to further explore the effect of COPD on the surgical outcomes of patients with CRC,aiming to provide more clinical reference for the surgical treatment and perioperative management of CRC patients with COPD.METHODS1.Firstly,we conducted a detailed literature search on Pub Med,Embase and Cochrane Central Register databases until January 1,2023.To screen and identify studies reporting survival or mortality,complication rate,and hazard ratio(HR)of prognostic factors after CRC resection in patients with and without COPD.A meta-analysis of survival HR values from each study was performed to assess whether there were differences in postoperative survival in colorectal cancer patients with and without COPD.The odds ratio(OR)was selected for a meta-analysis to analyze the difference in postoperative complications between colorectal cancer patients with and without COPD.And a one-arm meta-analysis was respectively performed on 30-day and 5-year mortality in CRC patients with COPD,CRC patients without COPD,CRC patients with zero acute chronic obstructive pulmonary disease(AECOPD)attacks within 1 year before surgery,and that with a history of AECOPD attacks within 1 year before surgery,to determine the specific values of mortality in each group.2.Then,Clinical data of patients diagnosed with primary colorectal cancer and receiving colorectal cancer resection in our institution from January 2014 to December 2022 were retrospectively analyzed.A propensity matching analysis was performed to control confounding factors.Finally,56 CRC patients with COPD and56 CRC patients without COPD were included.The postoperative recovery were compared between the two matched groups.Kaplan-Meier survival curve and Log-rank test were drawn to analyze and compare the differences in overall survival(OS),cancer-specific survival and disease-free survival between COPD and non-COPD groups,and analyze the difference of OS between patients without AECOPD attacks and patients with a history of AECOPD attacks within 1 year before surgery in COPD group.Further COX regression analysis was performed to clarify the significantly influencing factors of overall survival of patients with CRC.Fine-Gray tests were used to analyze and establish a competitive risk model to observe whether there was a difference in the cumulative risk rate of tumor-related death between COPD and non-COPD patients after controlling for competitive risk events.RESULTS1.Meta-analysis found that: CRC Patients with COPD had significantly worse30-day and 5-year OS after CRC surgery than those without COPD(30-day OS,HR=1.74,95%CI: 1.45-2.10,P<0.0001;5-year OS,HR=1.24,95%CI: 1.16-1.33,P<0.0001);The CRC patients with a history of AECOPD attack within 1 year before surgery had significantly worse 5-year OS than that of patients without a history of AECOPD attack within 1 year before surgery(HR=1.24,95%CI: 1.05-1.45,P=0.009);Patients in the COPD group had a 30-day mortality rate about 9%(95%CI: 0-17%)and a 5-year mortality rate about 48%(95%CI: 41%--55%),while patients in the non-COPD group had a 30-day mortality rate about 3%(95%CI: 0-7%)and a 5-year mortality rate about 42%(95%CI: 38%-47%);CRC patients with zero preoperative AECOPD attacks had a 5-year mortality rate about 66%(95%CI: 63-69%),while patients with ≥1 preoperative AECOPD attacks had a 5-year mortality rate about 81%(95%CI: 76%-86%);Compared with CRC patients without COPD,the ICU admission rate(OR=1.65,95%CI : 1.38-1.98,P<0.001),invasive assisted ventilation rate(OR=1.78,95%CI:1.29-2.45,P<0.001),reoperation rate(OR=1.40,95%CI:1.20-1.64,P<0.001),incision dehiscence rate(OR=2.05,95%CI : 1.60-2.61,P<0.001),pneumonia(OR=2.05,95%CI:1.60-2.61,P=0.007)and heart failure(OR=2.46,95%CI:1.47-4.10,P<0.001)are higher in the CRC patients with COPD.2.Single-center retrospective study found that: COPD and TNM stage were significantly independent risk factors affecting overall postoperative survival of patients with CRC;COPD was not associated with cancer-specific survival or disease-free survival in CRC patients;COPD had no effect on operation duration,anesthesia duration,total hospital stay and postoperative hospital stay in CRC patients;COPD prolonged catheter removal time and first defecation time after CRC surgery,but had no effect on abdominal drainage tube removal time;ICU occupancy rates,invasive and non-invasive assisted ventilation rates,and bronchoscopy rates were significantly higher in COPD group than in non-COPD group after CRC resection;Compared with patients without COPD,those with COPD had a higher incidence of pneumonia and septic shock after CRC resection.In COPD group,there was no significant difference in postoperative OS among CRC patients with or without AECOPD attack 1 year before surgery.CONCLUSIONS1.COPD is an independent risk factor affecting postoperative survival of CRC patients,but it is not associated with postoperative cancer-specific survival.2.The incidence of complications,ICU admission rate and assisted ventilation rate after surgical treatment in CRC patients with COPD were significantly higher than those without COPD.