Surgical treatment of patients with colorectal cancer and comorbid cardiovascular diseases (results of a retrospective study)

AIM: to evaluate the impact of comorbid cardiovascular disease on surgical outcomes in patients with colorectal cancer.

PATIENTS AND METHODS: a single-center retrospective study of the early outcomes included 457 patients who underwent elective surgery with resection of the primary tumor for stage 0–4 colorectal cancer from January 2022 to December 2024. The main group included 285 patients with colorectal cancer and verified diagnosis of cardiovascular disease, necessarily including coronary artery disease. The control group consisted of 172 patients with colorectal cancer and without coronary artery disease. The primary endpoints of the study were: the incidence of postoperative complications and postoperative mortality, determined within 30 days after surgery for colorectal cancer. Secondary endpoints were: the surgery volume and access, the anastomotic leakage and colostomy rate.

RESULTS: the Charlson Comorbidity Index (6 [5;8] versus 4 [3;5]) and the ASA in patients in the main group were higher compared to the control group, respectively (p < 0.001). The volumes of surgery for all tumors were comparable. In the main group, laparotomy was used more often — 42/285 (14.7%), in the control group — 12/172 (7.0%), p = 0.013. In the main group, they more often refused for primary anastomosis (Hartmann's procedure in 30/285 patients (10.5%) vs 4/172 (2.3%) in the control group, p < 0.001). The postoperative morbidity was higher in the main group — 91/285 (31.9%), in the control group — 30/172 (17.4%) (odds ratio (OR) 2.22; 95% confidence interval (CI): 1.39–3.54; р < 0.001) due to an increased risk of cardiovascular complications. Complications of grade IV (A + B) severity according to Clavien-Dindo in the main group was detected in 13/285 (4.6%) of all patients, in the control group — 1/172 0.6% (OR 8.17; 95% CI: 1.06–63.04; р = 0.022). Postoperative mortality in the main group was 2/285 (0.7%), in the control group — 0/172 (0%), without a reliable difference in statistically significant differences in values (OR 3.04; 95% CI: 0.15–62.5; р = 0.530).

CONCLUSION: comorbid cardiovascular disease and coronary artery disease significantly impact the outcomes of surgery for colorectal cancer. These patients should be managed in multidisciplinary hospitals. Percutaneous coronary interventions should be performed first.

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