Gökdere OG, Öndeş B, Kanat BH, Ünlü S. Weak grip, weak anastomosis? Handgrip strength and sarcopenia as predictors of anastomotic leakage after colorectal cancer surgery. World J Gastrointest Surg 2026; 18(5): 118468 [DOI: 10.4240/wjgs.v18.i5.118468]
Corresponding Author of This Article
Osman G Gökdere, MD, Assistant Professor, Department of General Surgery, Malatya Turgut Özal University, Alacakapı Mahallesi, Battalgazi, Malatya 44090, Türkiye. osman.gokdere@ozal.edu.tr
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Surgery
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Gökdere OG, Öndeş B, Kanat BH, Ünlü S. Weak grip, weak anastomosis? Handgrip strength and sarcopenia as predictors of anastomotic leakage after colorectal cancer surgery. World J Gastrointest Surg 2026; 18(5): 118468 [DOI: 10.4240/wjgs.v18.i5.118468]
World J Gastrointest Surg. May 27, 2026; 18(5): 118468 Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.118468
Weak grip, weak anastomosis? Handgrip strength and sarcopenia as predictors of anastomotic leakage after colorectal cancer surgery
Osman G Gökdere, Bahadır Öndeş, Burhan H Kanat, Serkan Ünlü
Osman G Gökdere, Bahadır Öndeş, Burhan H Kanat, Department of General Surgery, Malatya Turgut Özal University, Malatya 44090, Türkiye
Serkan Ünlü, Department of Radiology, Malatya Training and Research Hospital, Malatya 44330, Türkiye
Author contributions: Gökdere OG interpreted the results, and drafted the manuscript; Gökdere OG and Öndeş B contributed to study design; Öndeş B and Kanat BH contributed to data collection and statistical analysis; Öndeş B assisted in manuscript writing; Kanat BH contributed to literature review; Ünlü S performed the radiological evaluation, contributed to the imaging-based sarcopenia assessment and provided data interpretation.
AI contribution statement: No AI tools such as ChatGPT or similar platforms were used to generate the scientific content of this manuscript. We would like to clarify that the study design, data collection, statistical analyses, and interpretation of the results are entirely the responsibility of the authors. All data presented in this manuscript are original and were obtained in accordance with approved ethical standards.
Institutional review board statement: This study was approved by the Ethics Committee of Malatya Turgut Özal University (Approval No. E-30785963-020-329253) and was conducted in accordance with the principles of the Declaration of Helsinki.
Informed consent statement: As this was a retrospective study and patient data were anonymized, individual patient consent was not required. All procedures were conducted in accordance with routine preoperative clinical consents and were approved by the institutional ethics committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Due to patient privacy and ethical restrictions, the underlying raw data are not publicly available in accordance with institutional data protection regulations. However, de-identified data can be made available from the corresponding author upon reasonable request and with permission from Malatya Turgut Özal University institutional authorities.
Corresponding author: Osman G Gökdere, MD, Assistant Professor, Department of General Surgery, Malatya Turgut Özal University, Alacakapı Mahallesi, Battalgazi, Malatya 44090, Türkiye. osman.gokdere@ozal.edu.tr
Received: January 4, 2026 Revised: January 18, 2026 Accepted: February 27, 2026 Published online: May 27, 2026 Processing time: 145 Days and 7.1 Hours
Abstract
BACKGROUND
Anastomotic leakage is one of the most severe complications after colorectal cancer surgery. Sarcopenia and impaired functional muscle performance have been increasingly recognized as potential predictors of postoperative morbidity.
AIM
To investigate whether radiological sarcopenia and preoperative handgrip strength independently predict anastomotic leakage in patients undergoing colorectal cancer resection with primary anastomosis.
METHODS
This single-center retrospective study reviewed patients who underwent elective colorectal cancer surgery with primary anastomosis between January 2020 and June 2024. Preoperative handgrip strength was available for 117 patients who constituted the study group. Sarcopenia was defined using computed tomography-derived skeletal muscle index at the third lumbar vertebra level. Tumor-related and surgery-related variables were recorded. Independent predictors of anastomotic leakage were identified using multivariable logistic regression, and model discrimination was evaluated using receiving operator curve analysis.
RESULTS
Among the 117 analyzed patients, 14 (12.0%) developed anastomotic leakage. Patients with leakage had significantly lower skeletal muscle index and weaker handgrip strength. In multivariable analysis, sarcopenia, low handgrip strength, American Society of Anesthesiologists score, and operative time were independently associated with an increased risk of anastomotic leakage (all P < 0.05). The predictive model demonstrated good discrimination with an area under the curve of 0.83 (95% confidence interval: 0.76-0.91).
CONCLUSION
Radiological sarcopenia and reduced handgrip strength independently predict anastomotic leakage after colorectal cancer surgery, supporting the integration of muscle strength and computed tomography-based muscle mass measures for improved preoperative risk stratification.
Core Tip: Anastomotic leakage remains a major cause of morbidity after colorectal cancer surgery, yet current risk stratification models rely predominantly on technical and anatomical factors. This study demonstrates that both radiological sarcopenia and reduced preoperative handgrip strength are strong and independently associated predictors of anastomotic leakage. Notably, functional muscle strength showed a particularly robust association with leakage risk, underscoring the importance of incorporating functional assessments alongside morphometric measures. Simple, low-cost handgrip testing may enhance preoperative risk evaluation and help identify patients who could benefit from targeted prehabilitation or protective surgical strategies.
