# Postoperative Survival Analysis of Elective Colorectal Cancer Surgery with Liver Cirrhosis: A Propensity-Matched Study

## TL;DR

This study finds that patients with liver cirrhosis undergoing colorectal cancer surgery face higher risks and worse long-term survival, with preoperative albumin levels being a key predictor.

## Contribution

The study provides novel evidence on long-term survival and risk factors in cirrhotic patients undergoing colorectal surgery using propensity-matched analysis.

## Key findings

- Cirrhotic patients had significantly worse postoperative survival compared to non-cirrhotic controls.
- Preoperative hypoalbuminemia independently predicted long-term mortality in cirrhotic patients.
- Right hemicolectomy outcomes in cirrhotic patients were comparable to non-cirrhotic patients despite poorer long-term survival.

## Abstract

Patients with liver cirrhosis are at increased risk of multiple complications, most notably postoperative hepatic decompensation and renal impairment. Due to the increased surgical risk associated with the condition, operative interventions are undertaken less frequently in this population, resulting in limited evidence regarding short- and long-term survival and accurate risk assessment across diverse clinical backgrounds and comorbidities. In this study, we evaluated the clinical outcomes of 53 patients with liver cirrhosis compared with non-cirrhotic controls using a propensity score-matched analysis. Our findings demonstrated that liver cirrhosis was independently associated with reduced postoperative survival, even after stratification via the Child–Turcotte–Pugh classification. Moreover, preoperative serum albumin emerged as a critical prognostic factor influencing overall survival.

Background: Liver cirrhosis increases perioperative risk in colorectal cancer surgery, yet data on long-term outcomes remain limited. In this study, we evaluated postoperative morbidity, mortality, and survival in cirrhotic patients. Methods: In this single-center retrospective cohort, 53 cirrhotic patients undergoing elective colectomy or proctectomy (2011–2022) were propensity score-matched 1:1 with non-cirrhotic controls. Perioperative variables, complications, and survival were analyzed. Subgroup analyses were performed for right hemicolectomy and non-right hemicolectomy procedures. Kaplan–Meier and logistic regression analyses were implemented to assess outcomes and risk factors. Results: Cirrhotic patients had higher preoperative MELD-Na scores and lower albumin and hemoglobin levels. They experienced greater blood loss, longer operative times, more ICU admissions, and higher rates of major complications (18.9% vs. 3.8%, p = 0.01). Mortality was higher at in-hospital (7.5% vs. 0%), 3-month (9.4% vs. 0%), and 60-month (66% vs. 28.3%) intervals, and these patients’ overall survival was shorter (70.7 vs. 116.8 months, p < 0.001). The subgroup analysis showed that the adverse impact of cirrhosis persisted for both right hemicolectomy and non-right hemicolectomy procedures, with significantly worse long-term survival in cirrhotic patients. Postoperative complications after right hemicolectomy did not differ significantly between groups. Among cirrhotic patients, Child–Turcotte–Pugh class B predicted worse survival than class A (40.1 vs. 84.8 months, p = 0.006). Preoperative hypoalbuminemia (<3.5 g/dL) independently predicted long-term mortality (HR = 3.93). Conclusions: Elective colorectal surgery in patients with cirrhosis is associated with increased perioperative complications and significantly reduced long-term survival. However, postoperative outcomes after right hemicolectomy in cirrhotic patients were comparable to those of non-cirrhotic patients, despite their persistently poorer long-term survival. Optimization of nutritional status and careful preoperative assessment of hepatic reserve are essential to improving outcomes in this high-risk population.