Risk factors and long-term impact of anastomotic leak after colorectal cancer surgery in the elderly: a 5-year follow-up study
- 1Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
- 2Hepatobiliary and Transplant Surgery Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
- 3Colorectal Surgery, Department of General and Digestive Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
Abstract
Background: The elderly population represents an increasing proportion of patients undergoing surgery for colorectal cancer. Their risks and outcomes may differ from the general population. This study aimed to identify risk factors associated with anastomotic leak (AL) and the outcomes related to this complication in elderly patients, using a large retrospective cohort from a high-volume colorectal surgery unit.
Methods: A retrospective cohort study was conducted including patients aged ≥ 75 years who underwent colorectal cancer surgery between January 2015 and March 2019 at a tertiary centre. Univariable and multivariable logistic regression analyses were used to identify predictors of AL. Kaplan–Meier and Cox regression analyses assessed long-term survival.
Results: A total of 416 patients (mean age 81.3 ± 4.7 years, 56% male) were included, with AL occurring in 12.26% (n = 51). Independent predictors of AL included preoperative hypoalbuminemia < 3 g/dL (OR 7.70, p = 0.009), mechanical anastomosis (OR 3.13, p = 0.033), and elevated CRP on postoperative day 3 (OR 1.14 per unit, p < 0.001). Intraoperative drain placement was protective (OR 0.34, p = 0.040). AL was associated with higher major complication rates, prolonged hospital stay, and increased 30-day and 5-year mortality (p < 0.0001). Discharge to rehabilitation centre or hospital-at-home discharge remained associated with AL (OR 4.57, p = 0.011). Independent predictors of mortality included emergency surgery, AL, ECOG ≥ 2, and Clinical Frailty Scale ≥ 5.
Conclusions: These findings may support improved preoperative decision-making, patient counselling, and development of strategies to optimise outcomes in high-risk elderly patients.
Related
- Long-term oncologic outcomes associated with clinically significant anastomotic leakage after curative colorectal cancer surgery: Stage- and location-stratified analyses
- Clinical outcomes and recovery impact of implementing enhanced recovery after surgery (ERAS) pathway in elderly patients with gynecological malignant tumors
- The Role of Intraoperative Indocyanine Green Fluorescence Angiography in Reducing Anastomotic Leak After Colorectal Resection: A Systematic Review of Randomised Controlled Trials
- Impact of preoperative frailty and sarcopenia on short-term functional recovery after cardiac surgery in elderly patients: a prospective cohort study.
- The influencing factors of postoperative sleep disturbance in elderly patients undergoing transurethral prostate surgery and the construction and validation of a machine learning prediction model
BibTeX
@article{blancocolino2026risk,
title = {{Risk factors and long-term impact of anastomotic leak after colorectal cancer surgery in the elderly: a 5-year follow-up study}},
author = {R. Blanco-Colino and G. Pellino and F. Marinello and M. Martí Gallostra and E. Mena Muñoz and M. Kraft and N. Ortega-Torrecilla and J. L. Sánchez-García and A. Solís Peña and F. Vallribera and E. Espín-Basany},
journal = {Techniques in Coloproctology},
year = {2026},
month = jul,
doi = {10.1007/s10151-026-03397-3},
url = {https://doi.org/10.1007/s10151-026-03397-3},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Risk factors and long-term impact of anastomotic leak after colorectal cancer surgery in the elderly: a 5-year follow-up study
AU - R. Blanco-Colino
AU - G. Pellino
AU - F. Marinello
AU - M. Martí Gallostra
AU - E. Mena Muñoz
AU - M. Kraft
AU - N. Ortega-Torrecilla
AU - J. L. Sánchez-García
AU - A. Solís Peña
AU - F. Vallribera
AU - E. Espín-Basany
PY - 2026
DA - 2026/07/31
JO - Techniques in Coloproctology
DO - 10.1007/s10151-026-03397-3
UR - https://doi.org/10.1007/s10151-026-03397-3
AB - Background: The elderly population represents an increasing proportion of patients undergoing surgery for colorectal cancer. Their risks and outcomes may differ from the general population. This study aimed to identify risk factors associated with anastomotic leak (AL) and the outcomes related to this complication in elderly patients, using a large retrospective cohort from a high-volume colorectal surgery unit. Methods: A retrospective cohort study was conducted including patients aged ≥ 75 years who underwent colorectal cancer surgery between January 2015 and March 2019 at a tertiary centre. Univariable and multivariable logistic regression analyses were used to identify predictors of AL. Kaplan–Meier and Cox regression analyses assessed long-term survival. Results: A total of 416 patients (mean age 81.3 ± 4.7 years, 56% male) were included, with AL occurring in 12.26% (n = 51). Independent predictors of AL included preoperative hypoalbuminemia < 3 g/dL (OR 7.70, p = 0.009), mechanical anastomosis (OR 3.13, p = 0.033), and elevated CRP on postoperative day 3 (OR 1.14 per unit, p < 0.001). Intraoperative drain placement was protective (OR 0.34, p = 0.040). AL was associated with higher major complication rates, prolonged hospital stay, and increased 30-day and 5-year mortality (p < 0.0001). Discharge to rehabilitation centre or hospital-at-home discharge remained associated with AL (OR 4.57, p = 0.011). Independent predictors of mortality included emergency surgery, AL, ECOG ≥ 2, and Clinical Frailty Scale ≥ 5. Conclusions: These findings may support improved preoperative decision-making, patient counselling, and development of strategies to optimise outcomes in high-risk elderly patients.
SN - 1123-6337
SN - 1128-045X
ER -