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Colorectal Cancer Surgical Treatments · Journal article
World Journal of Gastrointestinal Surgery · September 4, 2026
Encouraging direction, but not yet definitive.
This single-center retrospective cohort of 200 patients identified seven independent perioperative risk factors for anastomotic leakage (AL), which occurred in 11% of cases and was associated with substantial reductions in 5-year overall survival (63.6% vs 82.6%, p=0.003) and disease-free survival (54.5% vs 77.5%, p=0.001). The findings suggest AL is a meaningful adverse prognostic marker and point to modifiable perioperative targets, but require confirmation in prospective multicentre cohorts.
Single-center retrospective cohort study. Patients undergoing elective radical resection for colorectal cancer at Department of General Surgery, First Affiliated Hospital of Bengbu Medical University; eligibility criteria not fully specified in abstract.. Intervention: Radical colorectal resection (with or without protective stoma); neoadjuvant therapy status recorded.. Compared with: Patients with anastomotic leakage within 30 days vs. those without leakage.. n = 200. Single center: First Affiliated Hospital of Bengbu Medical University, China.
Anastomotic leakage occurred in 22 of 200 patients (11.0%) Independent risk factors included BMI ≥25 kg/m² (OR=2.354, 95%CI 1.196–4.632, p=0.013), diabetes mellitus (OR=2.660, 95%CI 1.258–5.624, p=0.010), rectal tumor location (OR=2.440, 95%CI 1.198–4.970, p=0.014), neoadjuvant therapy (OR=2.186, 95%CI 1.042–4.584, p=0.039), preoperative albumin <35 g/L (OR=2.680, 95%CI 1.278–5.620, p=0.009), operation time ≥180 minutes (OR=2.334, 95%CI 1.142–4.770, p=0.020), and intraoperative blood loss ≥200 mL (OR=2.142, 95%CI 1.024–4.482, p=0.043) Protective stoma reduced AL risk (OR=0.403, 95%CI 0.174–0.932, p=0.034)
5-year disease-free survival was 54.5% (AL group) vs 77.5% (non-AL group), Log-rank p=0.001; AL was an independent adverse prognostic factor by Cox regression (HR=2.048, 95%CI 1.312–3.198, p=0.002)
Clinicians should identify patients with multiple risk factors (obesity, diabetes, rectal location, neoadjuvant therapy, low preoperative albumin, prolonged operation, significant blood loss) and consider protective stoma placement in high-risk cases to reduce anastomotic leakage and its associated substantial long-term oncological harm. The data support preoperative nutritional and glycemic optimization as part of risk mitigation strategy.
Single-center retrospective cohort identifying multiple independent risk factors for anastomotic leakage and demonstrating significant impact on 5-year survival and disease-free survival, but limited by retrospective design and modest sample size.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should identify patients with multiple risk factors (obesity, diabetes, rectal location, neoadjuvant therapy, low preoperative albumin, prolonged operation, significant blood loss) and consider protective stoma placement in high-risk cases to reduce anastomotic leakage and its associated substantial long-term oncological harm. The data support preoperative nutritional and glycemic optimization as part of risk mitigation strategy.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
BACKGROUNDAnastomotic leakage (AL) is one of the severe complications developed after radical colorectal cancer (CRC) surgery that has an incidence between 3% and 19%, and might also severely deteriorate long-term oncological outcomes.The perioperative management of high-risk patients requires that they be identified pre-operatively.We sought to determine independent risk factors for AL and assess the prognostic effect of AL in patients who underwent surgery with curative intent for CRC. AIMTo investigate the incidence, independent risk factors, and impact on short-term and long-term prognosis of AL following radical CRC surgery, and to provide clinical evidence for perioperative risk stratification and management.METHODS A single-center retrospective cohort study was conducted, collecting data from 200 patients who underwent elective radical resection for CRC at the Department of General Surgery, the First Affiliated Hospital of Bengbu Medical University, from January 2019 to December 2024.Patients were divided into an AL group (n = 22) and a non-AL group (n = 178) based on whether AL occurred within 30 days postoperatively.Univariate and multivariate logistic regression analyses were used to identify independent risk factors.The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate the impact of AL on overall survival (OS) and disease-free survival (DFS).Action-Process-Object-Schema theory combined with principles of critical thinking ability assessment was used as a supplementary framework to organize perioperative risk evaluation and clinical interpretation.RESULTS AL occurred in 22 of 200 patients (11.0%).Multivariate logistic regression identified body mass index ≥ 25 kg/m² [odds ratio (OR) = 2.354, 95%CI: 1.196-4.632,P = 0.013], 4 / 29 diabetes mellitus (OR = 2.660, 95%CI: 1.258-5.624,P = 0.010), rectal tumor location (OR = 2.440, 95%CI: 1.198-4.970,P = 0.014), neoadjuvant therapy (OR = 2.186, 95%CI: 1.042-4.584,P = 0.039), preoperative albumin < 35 g/L (OR = 2.680, 95%CI: 1.278-5.620,P = 0.009), operation time ≥ 180 minutes (OR = 2.334, 95%CI: 1.142-4.770,P = 0.020), and intraoperative blood loss ≥ 200 mL (OR = 2.142, 95%CI: 1.024-4.482,P = 0.043) as independent risk factors; protective stoma (OR = 0.403, 95%CI: 0.174-0.932,P = 0.034) was a protective factor.The AL group had significantly longer hospital stay, higher overall complication rate, higher reoperation rate, higher permanent stoma rate, and higher rate of adjuvant chemotherapy delay (all P < 0.05).Kaplan-Meier analysis demonstrated that the 5-year overall survival rate was 63.6% vs 82.6% (Log-rank P = 0.003), and DFS rate was 54.5% vs 77.5% (Log-rank P = 0.001) in the AL vs non-AL groups, respectively.Multivariate Cox regression confirmed AL as an independent adverse prognostic factor for DFS (hazard ratio = 2.048, 95%CI: 1.312-3.198,P = 0.002).CONCLUSION AL following radical CRC surgery is associated with multiple perioperative risk factors and significantly impairs both short-term and long-term prognosis.Preoperative nutritional and glycemic optimization, judicious use of protective stoma in high-risk patients, and reduction of intraoperative stress are key strategies to reduce AL incidence and improve patient outcomes.The Action-Process-Object-Schema-informed critical thinking framework may further enhance the clinical interpretation and application of perioperative risk assessment.
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