Long-term oncologic outcomes associated with clinically significant anastomotic leakage after curative colorectal cancer surgery: Stage- and location-stratified analyses
- 1Division of Colon and Rectal surgery, Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
- 2Department of Medical Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
Abstract
Background: Clinically significant anastomotic leakage (AL) after colorectal cancer surgery is associated with substantial postoperative morbidity, but its long-term oncologic impact remains uncertain. We evaluated the association of AL with long-term survival, including stage- and location-specific patterns, after curative colorectal cancer surgery. Methods: We retrospectively reviewed consecutive patients who underwent curative surgery for non-metastatic colorectal adenocarcinoma between 2004 and 2018. Clinically significant AL was defined as grade B or C leakage. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan–Meier and multivariable Cox regression analyses. Subgroup and formal interaction analyses were performed according to tumor stage and location. Results: Among 2,122 patients, 63 (3.0%) developed clinically significant AL. After multivariable adjustment, including treatment era, AL was not independently associated with OS (HR, 1.581; 95% CI, 0.923–2.707; p = 0.095) or DFS (HR, 1.325; 95% CI, 0.812–2.161; p = 0.260). In stage III disease, patients with AL had lower 5-year OS (56.3% vs. 76.3%; p = 0.005) and DFS (43.9% vs. 68.4%; p = 0.007). However, formal interaction testing showed no significant effect modification by tumor stage (OS, p for interaction = 0.132; DFS, p for interaction = 0.141) or tumor location (OS, p for interaction = 0.775; DFS, p for interaction = 0.748). Conclusions: Clinically significant AL was not independently associated with long-term oncologic outcomes in the overall cohort. Although poorer survival was observed in the stage III subgroup, the absence of significant interaction indicates that these stage- and location-specific findings should be interpreted as exploratory rather than evidence of differential AL effects.
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BibTeX
@article{jeon2026longterm,
title = {{Long-term oncologic outcomes associated with clinically significant anastomotic leakage after curative colorectal cancer surgery: Stage- and location-stratified analyses}},
author = {Youngbae Jeon and Sun Jin Sym and Won-Suk Lee and Jeong-Heum Baek},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359416},
url = {https://doi.org/10.1371/journal.pone.0359416},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long-term oncologic outcomes associated with clinically significant anastomotic leakage after curative colorectal cancer surgery: Stage- and location-stratified analyses
AU - Youngbae Jeon
AU - Sun Jin Sym
AU - Won-Suk Lee
AU - Jeong-Heum Baek
PY - 2026
DA - 2026/10/01
JO - PLOS One
DO - 10.1371/journal.pone.0359416
UR - https://doi.org/10.1371/journal.pone.0359416
AB - Background: Clinically significant anastomotic leakage (AL) after colorectal cancer surgery is associated with substantial postoperative morbidity, but its long-term oncologic impact remains uncertain. We evaluated the association of AL with long-term survival, including stage- and location-specific patterns, after curative colorectal cancer surgery. Methods: We retrospectively reviewed consecutive patients who underwent curative surgery for non-metastatic colorectal adenocarcinoma between 2004 and 2018. Clinically significant AL was defined as grade B or C leakage. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan–Meier and multivariable Cox regression analyses. Subgroup and formal interaction analyses were performed according to tumor stage and location. Results: Among 2,122 patients, 63 (3.0%) developed clinically significant AL. After multivariable adjustment, including treatment era, AL was not independently associated with OS (HR, 1.581; 95% CI, 0.923–2.707; p = 0.095) or DFS (HR, 1.325; 95% CI, 0.812–2.161; p = 0.260). In stage III disease, patients with AL had lower 5-year OS (56.3% vs. 76.3%; p = 0.005) and DFS (43.9% vs. 68.4%; p = 0.007). However, formal interaction testing showed no significant effect modification by tumor stage (OS, p for interaction = 0.132; DFS, p for interaction = 0.141) or tumor location (OS, p for interaction = 0.775; DFS, p for interaction = 0.748). Conclusions: Clinically significant AL was not independently associated with long-term oncologic outcomes in the overall cohort. Although poorer survival was observed in the stage III subgroup, the absence of significant interaction indicates that these stage- and location-specific findings should be interpreted as exploratory rather than evidence of differential AL effects.
SN - 1932-6203
ER -