The Association between Modifiable Lifestyle Factors and Postoperative Complications of Elective Surgery in Patients with Colorectal Cancer

Lisanne Loogman, Lindsey C.F. De Nes, Thea C. Heil, Dieuwertje E.G. Kok, Renate M. Winkels, Ellen Kampman, Johannes H.W. De Wilt*, Fränzel J.B. Van Duijnhoven, Peter Van Duijvendijk, Henk K. Van Halteren, Bibi M.E. Hansson, Ewout A. Kouwenhoven, Flip M. Kruyt, Paul C. Van De Meeberg, Renzo Pieter Veenstra, Evertine Wesselink, Moniek Van Zutphen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)


BACKGROUND: Research has demonstrated a possible relation between patients' preoperative lifestyle and postoperative complications. OBJECTIVE: This study aimed to assess associations between modifiable preoperative lifestyle factors and postoperative complications in patients undergoing elective surgery for colorectal cancer. DESIGN: This is a retrospective study of a prospectively maintained database. SETTING: At diagnosis, data on smoking habits, alcohol consumption, BMI, and physical activity were collected by using questionnaires. Postoperative data were gathered from the nationwide database of the Dutch ColoRectal Audit. PATIENTS: Patients (n = 1564) with newly diagnosed stage I to IV colorectal cancer from 11 Dutch hospitals were included in a prospective observational cohort study (COLON) between 2010 and 2018. MAIN OUTCOME MEASURES: Multivariable logistic regression models were used to identify which preoperative lifestyle factors were associated with postoperative complications. RESULTS: Postoperative complications occurred in 28.5%, resulting in a substantially prolonged hospital stay (12 vs 5 days, p < 0.001). Independently associated with higher postoperative complication rates were ASA class II (OR, 1.46; 95% CI, 1.05-2.04; p = 0.03) and III to IV (OR, 3.17; 95% CI, 1.96-5.12; p < 0.001), current smoking (OR, 1.62; 95% CI, 1.02-2.56; p = 0.04), and rectal tumors (OR, 1.81; 95%CI, 1.28-2.55; p = 0.001). Body mass index, alcohol consumption, and physical activity did not show an association with postoperative complications. However, in a subgroup analysis of 200 patients with ASA III to IV, preoperative high physical activity was associated with fewer postoperative complications (OR, 0.17; 95% CI, 0.03-0.87; p = 0.04). LIMITATIONS: Compared with most studied colorectal cancer populations, this study describes a relatively healthy study population with 87.2% of the included patients classified as ASA I to II. CONCLUSIONS: Modifiable lifestyle factors such as current smoking and physical activity are associated with postoperative complications after colorectal cancer surgery. Current smoking is associated with an increased risk of postoperative complications in the overall study population, whereas preoperative high physical activity is only associated with a reduced risk of postoperative complications in patients with ASA III to IV. See Video Abstract at

Original languageEnglish
Pages (from-to)1342-1353
Number of pages12
JournalDiseases of the Colon and Rectum
Issue number11
Publication statusPublished - Nov 2021


  • Colorectal neoplasms
  • Colorectal surgery
  • Lifestyle
  • Postoperative complications


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