{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:10:09Z","timestamp":1788786609374,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Anastomotic leak remains a major complication after colorectal cancer surgery. While most studies focus on prediction or prevention, less is known about the clinical course after leak diagnosis. We aimed to evaluate the occurrence, severity, management, and early postoperative consequences of anastomotic leak after elective colorectal cancer surgery. Methods: This retrospective multicenter cohort study included consecutive patients undergoing elective colorectal cancer resection with restoration of bowel continuity in five tertiary referral centers. Patients without an evaluable anastomosis were excluded. The primary endpoint was 30-day anastomotic leak incidence. Secondary endpoints included Clavien\u2013Dindo severity, therapeutic management, major morbidity, surgical reintervention, length of hospital stay, intensive care unit admission, readmission, and 30-day mortality. Firth penalized logistic regression was used for adjusted analyses. Results: Among 943 patients with an evaluable anastomosis, 55 developed an anastomotic leak (5.8%). Leak was more frequent after rectal than colon cancer surgery (8.8% vs. 4.5%; crude OR 2.04, 95% CI 1.18\u20133.53; p = 0.016). After adjustment, rectal cancer remained independently associated with leak occurrence (adjusted OR 3.61, 95% CI 1.74\u20137.48; p &lt; 0.001), whereas intraoperative indocyanine green fluorescence angiography was not (adjusted OR 1.02, 95% CI 0.48\u20132.17; p = 0.962). Once leak occurred, 92.7% of patients developed major morbidity, 76.4% required surgical reintervention, and, among patients with available length-of-stay data, 65.4% had a postoperative hospital stay exceeding 14 days; 30-day mortality was 10.9%. Conclusions: Anastomotic leak occurred in fewer than 6% of elective colorectal cancer resections but was associated with severe postoperative deterioration. Its impact is better captured by evaluating severity, management, and downstream consequences, rather than incidence alone.<\/jats:p>","DOI":"10.3390\/jcm15176903","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:12:25Z","timestamp":1788783145000},"page":"6903","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Burden of Anastomotic Leak After Elective Colorectal Cancer Surgery: A Multicenter Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Tomasz","family":"Cwali\u0144ski","sequence":"first","affiliation":[{"name":"Department of General Surgery and Surgical Oncology, \u201cSaint Wojciech\u201d Hospital, \u201cNicolaus Copernicus\u201d Health Center, 80462 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9359-157X","authenticated-orcid":false,"given":"Patryk","family":"Kaczor","sequence":"additional","affiliation":[{"name":"Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toru\u0144, 87-100 Toru\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2894-4834","authenticated-orcid":false,"given":"Bartosz","family":"Kapturkiewicz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 53-413 Wroclaw, Poland"},{"name":"1st Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, Pl. Hirszfelda 12, 53-413 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5935-0633","authenticated-orcid":false,"given":"Maciej","family":"Ciesielski","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery, Gdynia Oncology Centre, 81-519 Gdynia, Poland"},{"name":"Department of Oncological Surgery, Faculty of Health Sciences with the Institute of Maritime and Tropical Medicine, Medical University of Gda\u0144sk, 81-519 Gdynia, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8080-3001","authenticated-orcid":false,"given":"Micha\u0142","family":"Kazanowski","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 53-413 Wroclaw, Poland"},{"name":"1st Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, Pl. Hirszfelda 12, 53-413 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0316-0186","authenticated-orcid":false,"given":"Zuzanna","family":"Bigus","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Surgical Oncology, \u201cSaint Wojciech\u201d Hospital, \u201cNicolaus Copernicus\u201d Health Center, 80462 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Pi\u0105tkowski","sequence":"additional","affiliation":[{"name":"Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toru\u0144, 87-100 Toru\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Januszkiewicz","sequence":"additional","affiliation":[{"name":"Department of General and Oncological Surgery, Voivodeship Hospital in Bialystok, 15-000 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"Lesiak","sequence":"additional","affiliation":[{"name":"1st Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, Pl. Hirszfelda 12, 53-413 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0988-5875","authenticated-orcid":false,"given":"Sergii","family":"Girnyi","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Surgical Oncology, \u201cSaint Wojciech\u201d Hospital, \u201cNicolaus Copernicus\u201d Health Center, 80462 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1163-1778","authenticated-orcid":false,"given":"Damian","family":"Nowi\u0144ski","sequence":"additional","affiliation":[{"name":"Department of General and Oncological Surgery, Voivodeship Hospital in Bialystok, 15-000 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8580-536X","authenticated-orcid":false,"given":"Piotr","family":"Kurek","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery, Gdynia Oncology Centre, 81-519 Gdynia, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Jackowski","sequence":"additional","affiliation":[{"name":"Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toru\u0144, 87-100 Toru\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"B\u0119benek","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Wroclaw University of Science and Technology, 53-413 Wroclaw, Poland"},{"name":"1st Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, Pl. Hirszfelda 12, 53-413 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Jagielski","sequence":"additional","affiliation":[{"name":"Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toru\u0144, 87-100 Toru\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9777-9588","authenticated-orcid":false,"given":"Luigi","family":"Marano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Academy of Applied Medical and Social Sciences-AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), AMiSNS Ul. Lotnicza 3, 82-300 Elbl\u0105g, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/DCR.0000000000003478","article-title":"Impact of Anastomotic Leakage After Colorectal Cancer Surgery on Quality of Life: A Systematic Review","volume":"68","author":"Gielen","year":"2025","journal-title":"Dis. Colon Rectum"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3111","DOI":"10.3390\/curroncol30030236","article-title":"Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?","volume":"30","author":"Tsalikidis","year":"2023","journal-title":"Curr. 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