• 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, and Dutch Surgical Colorectal Audit Group.
• Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
• J Surg Oncol. 2014 May 1;109(6):567-73.

BackgroundMortality following severe complications (failure-to-rescue, FTR) is targeted in surgical quality improvement projects. Rates may differ between colon- and rectal cancer resections.MethodsAnalysis 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.ResultsColon 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).ConclusionsSevere 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.© 2013 Wiley Periodicals, Inc.

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