Published online Oct 27, 2026. doi: 10.4240/wjgs.121006
Revised: June 8, 2026
Accepted: September 4, 2026
Published online: October 27, 2026
Processing time: 173 Days and 7.8 Hours
Anastomotic 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 cura
To 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.
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 evalua
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], 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).
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.
Core Tip: This retrospective cohort study evaluated the incidence, risk factors, and prognostic impact of anastomotic leakage (AL) after radical colorectal cancer surgery. Among 200 patients, AL occurred in 11.0% and was independently associated with body mass index ≥ 25 kg/m², diabetes mellitus, rectal tumor location, neoadjuvant therapy, hypoalbuminemia, prolonged operation time, and increased intraoperative blood loss, while protective stoma was a significant protective factor. Patients with AL had significantly worse short-term outcomes, including higher complication and reoperation rates, prolonged hospitalization, and delayed adjuvant chemotherapy. Importantly, AL was also associated with inferior long-term survival and was identified as an independent predictor of poorer disease-free survival.