Patients who survive colorectal cancer face a sustained and increased risk of death from chronic liver disease and cirrhosis long after surgery, according to a large population-based analysis from the United States.
Long Term Hepatic Risk
Hepatotoxicity is a recognised complication of colorectal cancer treatment, but the long-term impact on liver related mortality has not been well quantified. To address this, researchers analysed data from the Surveillance, Epidemiology, and End Results database covering the period from 1992 to 2021.
The study included patients diagnosed with colon or rectal cancer who underwent surgery. Using cumulative mortality functions, standardised mortality ratios and absolute excess risk, investigators compared deaths from chronic liver disease and cirrhosis among colorectal cancer survivors with those expected in the general population.
Overall, survivors of colorectal cancer experienced a significantly higher risk of liver related death. For colon cancer survivors, the standardised mortality ratio was 1.76, indicating a 76% higher risk than the general population. For rectal cancer survivors, the corresponding figure was 1.42, representing a 42% increase in risk.
Age And Cancer Site Matter
The excess risk was not evenly distributed across patient groups. The highest absolute excess risk of death from chronic liver disease and cirrhosis was observed in patients diagnosed with colon cancer between the ages of 60 and 69 years. This finding suggests that age at diagnosis and cancer site are important determinants of long-term liver outcomes.
Notably, the increased risk persisted even in the era of modern treatments, including targeted therapies and immunotherapy. This indicates that advances in oncological care have not eliminated the long-term burden of liver disease in this population.
Importantly, the analysis showed that long-term survivors of both colon and rectal cancer continue to face elevated liver related mortality many years after their initial treatment. This highlights that hepatic complications are not confined to the early post-treatment period but represent an ongoing risk.
Implications For Survivorship Care
The authors emphasise the need for personalised follow-up strategies that extend beyond cancer surveillance alone. Regular assessment of liver health, early identification of hepatic dysfunction and proactive management of modifiable risk factors may help mitigate long-term complications.
They conclude that comprehensive survivorship care for colorectal cancer patients should incorporate monitoring for chronic liver disease and cirrhosis. By integrating liver focused follow-up into routine care, clinicians may be able to reduce preventable deaths and improve long-term outcomes for this growing population of cancer survivors.
Reference
Wang L et al. Chronic liver disease and cirrhosis mortality following surgery for colon or rectal cancer. Scientific Reports. 2025;15:43736.
