Impact of statin therapy on postoperative outcomes following colorectal cancer surgery: A systematic review

Abstract

BACKGROUND

The pleiotropic effects of statins, including anti-inflammatory and immunomodulatory actions, have prompted investigation into their perioperative role in colorectal cancer (CRC) surgery. However, findings remain inconsistent due to heterogeneity in study designs, statin regimens, and outcome definitions. This reviews current observational evidence, emphasizing the duration of statin therapy and its association with postoperative outcomes.

AIM

To evaluate the association between statin therapy and postoperative outcomes in patients undergoing CRC surgery.

METHODS

A systematic literature search was conducted using PubMed and Google Scholar through March 2025. Five cohort studies evaluating statin use in CRC surgery were included. Primary outcomes assessed included anastomotic leak, surgical site infection, and 30-day and 90-day mortality. Data on statin duration and confounders such as comorbidities and surgical variables were also extracted.

RESULTS

Three studies investigated the rates of anastomotic leaks in patients who used statins compared to those who did not. Two of the studies found no significant difference, while one noted a marginally higher leak rate among statin users. Diabetes, smoking habits, and operative time were found to be common confounding factors. Conversely, the use of statins was consistently linked to a decrease in 30-day mortality in propensity-matched groups, although findings regarding 90-day mortality were variable.

CONCLUSION

Statin therapy may confer short-term survival benefits in CRC surgical patients, potentially via anti-inflammatory or cytoprotective mechanisms. While evidence regarding anastomotic leaks remains inconclusive, trends suggest improved postoperative outcomes. These findings are constrained by methodological heterogeneity, underscoring the need for prospective, randomized studies to confirm benefits and identify optimal patient subgroups.

Keywords: Colorectal cancer; Statin; 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor; Postoperative complications; Anastomotic leak; Mortality; Surgical site infection

Core Tip: This review evaluates the impact of statin therapy on postoperative outcomes following colorectal cancer surgery. The study focuses on cohort studies to show how statin use, particularly its timing and duration, may affect the risk of anastomotic leaks, surgical site infection, and short-term mortality. Despite conflicting data, a consistent trend toward reduced 30-day mortality was observed. Overall, these findings suggest the potential role of statins in colorectal cancer surgery, however due to the heterogeneity in definitions of statin therapy and limitations of study design there is a need for prospective studies to confirm their role in improving postsurgical outcomes.