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Risk Factors for Anastomotic Leaks in Simultaneous Resection of Primary Colon Cancer with Synchronous Liver
Allen T Yu1, Clark Pitcher1, Sergey Khaitov1
1Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Annals of Surgical Oncology
|June 27, 2026
Summary
Anastomotic leaks (AL) are a serious risk after combined colon cancer and liver metastasis surgery. Higher ASA scores, steroid use, major hepatectomies, and blood transfusions independently predict AL. Consider diversion or staged procedures for high-risk patients.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Anastomotic leaks (AL) are a significant complication following simultaneous resection of primary colon cancer and liver metastases.
- Identifying risk factors is crucial for mitigating this devastating outcome.
Purpose of the Study:
- To determine independent risk factors for anastomotic leaks (AL) in patients undergoing simultaneous colectomy and liver resection.
- To evaluate the impact of specific covariates on AL development using a nationwide database.
Main Methods:
- Utilized the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2014-2023).
- Included patients undergoing simultaneous colectomy and liver resection.
- Performed multivariate analysis and 2:1 propensity score matching (PSM) to identify AL predictors.
Main Results:
- Out of 1517 patients, 80 (5.3%) developed AL.
- Independent risk factors identified: higher ASA score (ORadj 2.55), chronic steroid use (ORadj 2.39), major hepatectomy (ORadj 1.92), and blood transfusion (ORadj 2.27).
- Propensity score matching confirmed a higher AL rate in patients receiving blood transfusions (10.7% vs. 5.0%, p < 0.01).
Conclusions:
- Higher ASA score, chronic steroid use, major hepatectomies, and blood transfusions are independent predictors of AL.
- These factors increase the risk of AL in patients undergoing combined colon cancer and liver metastasis resection.
- Consideration of fecal diversion or staged procedures is recommended for high-risk patient populations.
