{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T18:05:27Z","timestamp":1790877927074,"version":"4.1.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002631","name":"Gachon University","doi-asserted-by":"publisher","award":["GCU-202308190001"],"award-info":[{"award-number":["GCU-202308190001"]}],"id":[{"id":"10.13039\/501100002631","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013Meier and multivariable Cox regression analyses. Subgroup and formal interaction analyses were performed according to tumor stage and location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u20132.707; p\u2009=\u20090.095) or DFS (HR, 1.325; 95% CI, 0.812\u20132.161; p\u2009=\u20090.260). In stage III disease, patients with AL had lower 5-year OS (56.3% vs. 76.3%; p\u2009=\u20090.005) and DFS (43.9% vs. 68.4%; p\u2009=\u20090.007). However, formal interaction testing showed no significant effect modification by tumor stage (OS, p for interaction\u2009=\u20090.132; DFS, p for interaction\u2009=\u20090.141) or tumor location (OS, p for interaction\u2009=\u20090.775; DFS, p for interaction\u2009=\u20090.748).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359416","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:34:41Z","timestamp":1790876081000},"page":"e0359416","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term oncologic outcomes associated with clinically significant anastomotic leakage after curative colorectal cancer surgery: Stage- and location-stratified analyses"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1322-9536","authenticated-orcid":true,"given":"Youngbae","family":"Jeon","sequence":"first","affiliation":[{"name":"Gil Medical Center, Gachon University College of Medicine","place":["Incheon, Republic of Korea"],"department":["Division of Colon and Rectal surgery, Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sun Jin","family":"Sym","sequence":"additional","affiliation":[{"name":"Gil Medical Center, Gachon University College of Medicine","place":["Incheon, Republic of Korea"],"department":["Department of Medical Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won-Suk","family":"Lee","sequence":"additional","affiliation":[{"name":"Gil Medical Center, Gachon University College of Medicine","place":["Incheon, Republic of Korea"],"department":["Division of Colon and Rectal surgery, Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9124-8041","authenticated-orcid":true,"given":"Jeong-Heum","family":"Baek","sequence":"additional","affiliation":[{"name":"Gil Medical Center, Gachon University College of Medicine","place":["Incheon, Republic of Korea"],"department":["Division of Colon and Rectal surgery, Department of Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"issue":"3","key":"pone.0359416.ref001","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"F Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"pone.0359416.ref002","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1055\/s-0038-1676475","article-title":"Does Implementation of Enhanced Recovery after Surgery (ERAS) Protocols in Colorectal Surgery Improve Patient Outcomes?","volume":"32","author":"KA Ban","year":"2019","journal-title":"Clin Colon Rectal 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Zawadzki","year":"2016","journal-title":"Wideochir Inne Tech Maloinwazyjne"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359416","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:34:48Z","timestamp":1790876088000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359416"}},"subtitle":[],"editor":[{"given":"Chong-Chi","family":"Chiu","sequence":"first","affiliation":[{"name":"E-Da Cancer 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