Risk factors for infectious complications and postoperative outcomes of colorectal cancer patients with liver cirrhosis: a multicenter retrospective study.

PURPOSE: To evaluate the clinicopathological characteristics and postoperative outcomes of colorectal cancer (CRC) patients with preoperative liver cirrhosis (LC), using a multicenter database. METHODS: The subjects of this retrospective study were 6,012 patients who underwent colorectal surgery between 2016 and 2025. The patients were divided into an LC group (n = 44) and a no-LC group (n = 5,968). We analyzed their perioperative outcomes and risk factors for infectious complications. RESULTS: The LC group had significantly greater blood loss (40 mL vs. 20 mL, p < 0.001), higher rates of overall postoperative complications (52.3% vs. 18.4%, p < 0.001), and higher 30-day mortality (9.1% vs. 0.3%, p < 0.001) than the no-LC group. Infectious complications were also more frequent in the LC group (43.2% vs. 9.3%, p < 0.001). Multivariate analysis identified LC as a strong independent predictor of postoperative infectious complications (OR 6.780; 95% CI 3.663-12.548; p < 0.001). Notably, there were no 30-day deaths at facilities with dedicated intensive care unit (ICU) intensivists. CONCLUSIONS: Patients with advanced CRC are at high risk of complications from infections, which can result in a poor short-term prognosis. Thus, thorough preoperative evaluation and referral to a treatment facility with a well-established perioperative management system are essential for these high-risk patients.