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Article

Evaluation of Key Risk Factors Associated with Postoperative Complications in Colorectal Cancer Surgery

by
Silviu Stefan Marginean
1,
Mihai Zurzu
1,*,
Dragos Garofil
1,
Anca Tigora
1,
Vlad Paic
1,
Mircea Bratucu
1,
Florian Popa
1,
Valeriu Surlin
2,
Dan Cartu
2,
Victor Strambu
1 and
Petru Adrian Radu
1
1
Tenth Department of Surgery, University of Medicine and Pharmacy “Carol Davila” Bucharest, 013346 Bucharest, Romania
2
Sixth Department of Surgery, General Surgery Clinic I, Craiova Emergency Clinical Hospital, University of Medicine and Pharmacy of Craiova, 200642 Craiova, Romania
*
Author to whom correspondence should be addressed.
J. Mind Med. Sci. 2025, 12(1), 22; https://doi.org/10.3390/jmms12010022
Submission received: 19 March 2025 / Accepted: 8 April 2025 / Published: 17 April 2025
Versions Notes

Abstract

:
Background: Colorectal surgery remains a cornerstone in the management of colorectal cancer, yet postoperative complications continue to impact surgical outcomes. This study investigates key risk factors influencing morbidity, focusing on patient comorbidities, tumor characteristics, surgical techniques, and anastomotic methods. Methods: A retrospective analysis was conducted on 195 patients who underwent colorectal cancer surgery between January 2021 and December 2024 at the Clinical Hospital of Nephrology “Carol Davila”. Variables analyzed included patient demographics, comorbidities, tumor staging, surgical approach, and postoperative complications. Statistical methods included chi-square tests and multivariate logistic regression (significance threshold: p < 0.05). Results: The overall complication rate was 21%, with anastomotic leakage observed in 8.2% of cases. Significant risk factors for morbidity included cardiovascular disease (p = 0.001), chronic respiratory failure (p = 0.003), and chronic renal failure (p = 0.002). Laparoscopic surgery had a lower complication rate (7.1%) than open surgery (28%) (p = 0.003). Mechanical anastomosis showed lower complication rates than manual suturing (p = 0.009). Left-sided resections were associated with higher morbidity than right-sided procedures (p = 0.013). Conclusions: Optimizing colorectal surgery outcomes requires personalized perioperative strategies. Laparoscopic approaches and mechanical anastomosis significantly reduce complications. Further multicenter studies are needed to confirm these findings and enhance surgical guidelines.

1. Introduction

Colorectal surgery remains a cornerstone in the management of malignant diseases of the digestive tract [1]. Despite significant advancements in surgical techniques, perioperative care, and oncological therapies, the incidence of postoperative complications continues to be a major concern, with rates reported at approximately 30% [2]. The complexity of colorectal procedures, particularly in oncologic patients, stems from the necessity to re-establish bowel continuity while navigating the challenges of contamination, ischemia, and inflammation. These factors contribute to the heightened risk of morbidity, prolonged hospitalization, and, in severe cases, reintervention [3].
Colorectal cancer, a leading cause of mortality worldwide, poses unique surgical challenges due to the malignancy itself and the physiological burden imposed by tumor growth [4]. According to recent WHO statistics, it ranks second in cancer-related deaths, following lung neoplasia. Surgical resection remains the primary curative approach, yet the presence of systemic inflammation, impaired immune responses, and preoperative treatments such as chemotherapy and radiotherapy complicate the recovery process [5,6,7].
CRC can develop through inherited genetic mutations (10%), familial clustering (20%), or, most commonly, through sporadic mutations (70%) [8]. The gut microbiota, a diverse ecosystem of microorganisms in the gastrointestinal tract, plays a crucial role in CRC development and prevention [9]. Emerging evidence suggests that an imbalance in gut microbiota, termed dysbiosis, is linked to CRC pathogenesis through mechanisms such as chronic inflammation, oxidative stress, and DNA damage [10,11]. Additionally, the gut microbiota significantly influences postoperative outcomes in colorectal surgery [12]. Patients with balanced intestinal flora demonstrated significantly reduced rates of postoperative complications, such as infections, anastomotic leaks, ileus, incision-site metastasis, and delayed diarrhea, compared to patients experiencing dysbiosis. Moreover, patients receiving optimized bowel preparation and probiotic supplementation had superior wound healing outcomes, improved quality-of-life indicators (such as higher KPS scores and BMI), and shorter recovery periods [13].
Nanotechnology has emerged as a promising approach for improving CRC treatment by enhancing drug delivery, reducing systemic toxicity, and overcoming resistance mechanisms [14]. Nanotechnology enhances postoperative care by improving wound healing and infection prevention. Silver nanoparticles in dressings exhibit strong antimicrobial properties, reducing infections and accelerating healing. Nanostructured hydrogels promote tissue regeneration while minimizing scarring. Nanosensors enable real-time infection detection and intervention. Nanoengineered hydrogels prevent adhesions, reducing complications after surgery. These advancements significantly improve surgical outcomes [15].
In the context of CRC, integrating palliative care early in the treatment process has been associated with extended survival, reduced treatment costs, decreased healthcare-resource utilization, and improved quality of life. For patients with advanced-stage CRC, particularly those with metastatic disease, palliative care plays a crucial role in managing symptoms such as pain, bowel obstruction, and nutritional issues, thereby enhancing patient comfort and well-being [16,17,18]. Moreover, studies have demonstrated that early integration of palliative care in metastatic CRC patients not only enhances quality of life but also aligns treatment strategies with patient goals, potentially reducing unnecessary interventions and hospitalizations. This holistic approach ensures that treatment decisions are patient-centered, considering individual preferences and values [16,17,18]. Incorporating palliative care into the management plan for CRC patients, especially those with advanced disease, is essential for providing comprehensive care that addresses both the physical and psychosocial aspects of the illness. Healthcare providers should discuss palliative care options with their patients early in the treatment process to ensure optimal quality-of-life outcomes [16,17,18].
The occurrence of postoperative complications is multifactorial, influenced by patient-related aspects such as comorbidities, nutritional status, and immunosuppression, as well as tumor-specific features including histopathology, vascularization, and local invasion [19,20]. The surgeon’s expertise, intraoperative decision making, and technical precision further determine the overall outcome. Among the most concerning complications, anastomotic leakage represents a critical issue, often leading to peritoneal contamination, septic complications, and the need for additional surgical interventions [21,22]. Despite a meticulous technique, this remains one of the primary contributors to postoperative mortality [23]. Wound healing disorders are another frequent postoperative challenge, predisposing patients to infections, dehiscence, and the subsequent risk of incisional hernias. In addition, intraoperative and postoperative hemorrhage can lead to significant hemodynamic instability, necessitating transfusions and, in extreme cases, surgical revision [24].
Studies have highlighted the role of non-anemic iron deficiency as a potential perioperative risk factor, emphasizing the importance of iron metabolism in surgical recovery and immune function [25]. Additionally, emerging evidence suggests that cyclical and seasonal variations may impact postoperative outcomes, potentially due to fluctuations in hospital workload, environmental conditions, and immune responses [26]. Beyond physiological and biochemical factors, patient demographics and social determinants of health also play a crucial role in surgical recovery. Individuals with disabilities, for instance, face increased barriers to accessing quality surgical care, often leading to higher complication rates and longer hospital stays. These disparities highlight the need for tailored perioperative strategies to ensure equitable surgical outcomes for all patient populations [27]. Furthermore, the integration of minimally invasive techniques, such as laparoscopic and robotic-assisted surgery, has been associated with reduced surgical trauma and enhanced recovery pathways. Innovations in surgical technology, including fluorescence imaging and energy-based dissection tools, continue to refine colorectal cancer surgery, offering promising avenues for improving patient outcomes [28,29].
Beyond the first 30 days postsurgery, complications such as bowel dysfunction, anastomotic strictures, and chronic pain can significantly impair quality of life in the long term. The development of strictures following anastomotic healing often results in obstructive symptoms requiring further intervention. Furthermore, disturbances in bowel motility, particularly following low anterior resection, contribute to complications such as low anterior resection syndrome (LARS), which impacts sphincter function and bowel control [30,31]. The multifactorial nature of complications necessitates a comprehensive approach, incorporating precise surgical execution, rigorous patient selection, and tailored perioperative strategies. A thorough understanding of the risk factors influencing postoperative morbidity is essential for developing preventive measures and ensuring better long-term prognosis.
The objective of our study is to delineate risk factors associated with postoperative complications in colorectal cancer patients undergoing surgical treatment in our clinical setting, aiming to optimize preventive measures and improve long-term patient outcomes.

2. Methods

2.1. Study Design

We conducted a retrospective study between January 2021 and December 2024, analyzing a cohort of 195 patients diagnosed with colorectal cancer, who were admitted and treated in the Surgery Clinic of the Clinical Hospital of Nephrology Carol Davila Bucharest, Romania. Among them, 49 patients (25.1%) were diagnosed with stage IV disease, while the remaining 146 (74.9%) had stage I–III colorectal cancer, based on TNM classification.
All patients diagnosed with colorectal cancer were included in the study to provide a comprehensive evaluation of postoperative outcomes across a diverse patient population, regardless of disease stage or severity. This approach was chosen to reflect real-world clinical scenarios, where surgical candidates present with varying tumor burdens, comorbidities, and treatment histories. Including all cases, from early-stage to advanced-stage colorectal cancer, allows for a more holistic understanding of surgical risks and postoperative complications. To account for differences in disease severity, subgroup analyses were performed based on tumor staging (TNM classification), surgical approach (open vs. laparoscopic), and anastomotic technique (mechanical vs. manual). This stratification ensured that variations in severity were systematically assessed, mitigating potential confounding effects while preserving the inclusivity of the study cohort. Several key factors were considered in assessing the impact of risk variables on surgical outcomes, including age, sex, and comorbidities such as cardiovascular disease, diabetes, and chronic kidney disease. Tumor characteristics, particularly anatomical location and morphopathology, were evaluated for their role in surgical complexity and postoperative risks. These factors directly influenced treatment planning and technical challenges during surgery. The type of surgical intervention, whether open or minimally invasive, was analyzed to compare postoperative recovery and complication rates. Additionally, digestive tract continuity was restored using various anastomotic techniques, including manual suturing, linear staplers, and circular staplers. Tumor staging, classified according to the TNM system, was also assessed to determine its association with postoperative complications.
All patients received mechanical bowel preparation and prophylactic antibiotics, except for 32 who required urgent surgical intervention due to obstructive, perforated, or hemorrhagic colorectal cancer. In these cases, immediate surgery was prioritized over preoperative bowel preparation to prevent further deterioration and minimize the risk of septic complications. Preoperative radiotherapy was administered for anorectal malignancies per clinical guidelines, and postoperative care followed standard colorectal surgery protocols.
By integrating these clinical, surgical, and oncological parameters, the study aimed to identify the primary determinants influencing postoperative morbidity and overall treatment success in colorectal cancer surgery.

2.2. Data Collection and Statistical Analysis

Patient data were retrospectively collected from medical records of 195 individuals. Statistical analysis included descriptive statistics, chi-square or Fisher’s exact tests for categorical variables, and t-tests for continuous data. Multivariate logistic regression was applied to identify independent risk factors for postoperative complications. A p-value < 0.05 was considered statistically significant.

2.3. Ethical Considerations

This study was conducted in accordance with the Declaration of Helsinki and all applicable ethical regulations. Patient confidentiality was strictly maintained, and all participants were fully informed of their right to withdraw from the study at any time without any adverse consequences. The study protocol and procedures were reviewed and approved by the Ethics Committee of the Clinical Hospital of Nephrology Carol Davila, Bucharest (Approval No. 18, issued on 17 February 2025).

3. Results

The mean age of patients who underwent colorectal cancer surgery was 66 years, with an age range spanning from 16 to 91 years. The average body mass index was 27, with a standard deviation of 6.0. The study population exhibited a predominance of male patients, with 119 men and 76 women, yielding a male-to-female ratio of 1.57:1. Furthermore, a substantial proportion of individuals, representing 58% of the cohort (n = 113), had an ASA score of 3 or higher, reflecting the presence of significant systemic comorbidities that may impact perioperative risk and postoperative recovery.
Among the 195 patients included in the study, a significant proportion presented with pre-existing medical conditions that could potentially influence surgical outcomes and postoperative recovery. Cardiovascular diseases were the most prevalent comorbidities, affecting 117 patients (60%), with hypertension being the most common diagnosis. Other cardiovascular conditions, including atrial fibrillation, ischemic heart disease, valvular heart disease, heart failure, and a history of myocardial infarction or stroke, were also frequently encountered. Chronic respiratory failure was documented in 31 patients (16%), further contributing to perioperative risk. Diabetes mellitus was identified in 10 patients (5.3%), a condition known to impair wound healing and increase susceptibility to infections. Additionally, chronic renal failure was present in 17 patients (8.7%), a factor that can complicate fluid balance and perioperative management. A history of malignancy other than colorectal cancer was reported in 16 patients (8.2%).
Another important aspect of our investigation focused on the surgical approach and anastomotic techniques utilized. Among the 195 patients included in the study, 70 underwent laparoscopic procedures, while 125 underwent open surgery, enabling a comparative evaluation of postoperative recovery and complication rates. Digestive tract continuity was re-established in 145 cases through different anastomotic methods, including manual suturing in 9 cases, linear staplers in 43 cases, and circular staplers in 93 cases.
Among the study population, 132 patients (67.7%) had low- to intermediate-grade tumors, while 63 patients (32.3%) presented with high-grade malignancies, indicating a significant proportion of aggressive tumor behavior. Tumor staging was also assessed, with 146 patients (74.9%) diagnosed at stages I–III, reflecting cases with localized or regionally advanced disease, while 49 patients (25.1%) had stage IV disease, characterized by distant metastases and a higher risk of postoperative complications (Table 1).
A total of 195 colorectal cancer surgeries were performed, encompassing a variety of procedures tailored to tumor location. Right hemicolectomy was conducted in 24 cases (12.3%), while left hemicolectomy was performed in 19 cases (9.7%). Sigmoid resections were carried out in 33 patients (16.9%), and rectosigmoid resections in 18 cases (9.2%). Anterior rectal resection was the most frequent procedure, performed in 39 patients (20.0%), followed by rectal extirpation in 16 cases (8.2%). Hartmann’s procedure was utilized in 10 cases (5.1%), with subsequent reversal achieved in 9 patients (4.6%). Additionally, stoma confection was necessary for 15 patients (7.7%), and transverse colon resections were completed in 9 cases (4.6%). Other procedures were performed in three patients (1.5%) (Table 2).
Adenocarcinoma was the most frequently encountered histological subtype, being identified in 160 patients, representing 82.1% of the cases.
Among the 195 patients included in the study, postoperative complications were recorded in 41 cases (21%). Wound healing disorders were observed in 11 patients (5.6%), contributing to prolonged recovery and increased morbidity. Bleeding occurred in 11 cases (5.6%), presenting as 2 cases of subcutaneous hematoma, 5 cases of lower gastrointestinal bleeding, and 4 cases of hemoperitoneum. Anastomotic leaks were among the most concerning complications, affecting 16 patients (8.2%). Of these, 10 cases developed stercoral peritonitis, 2 cases led to entero-cutaneous fistulas, and 4 cases resulted in a low-flow anastomotic dehiscence. Evisceration was reported in three patients (1.5%), often requiring surgical intervention. Other complications accounted for six cases (3.1%), including two cases of uroperitoneum and three cases of intraperitoneal abscess formation (Table 3). The average period of hospitalization for the 195 patients was 21 days. For those who experienced postoperative complications, the hospital stay increased to an average of 33 days, representing 57% of cases.
The overall mortality rate was 11.7%, with 23 recorded deaths. Among these, six patients underwent surgical reinterventions for postoperative complications, leading to a 14% mortality rate among those who required additional procedures. Furthermore, four patients required multiple reinterventions due to recurrent postoperative complications, reflecting a complex clinical course that necessitated repeated surgical management.
The statistical analysis revealed no significant correlation between patient age and the occurrence of postoperative complications. Despite an age range spanning from 36 to 90 years, there was no clear association between advanced age and increased morbidity. Conversely, the statistical analysis confirmed that tumor grade, disease stage, surgical approach, anastomotic technique, and tumor location significantly influenced postoperative outcomes. High-grade tumors were strongly associated with increased complication rates (p = 0.004). Similarly, a significant correlation was observed between advanced-stage tumors and postoperative complications (p = 0.001), highlighting the increased surgical risk in metastatic disease.
Comorbidities also played a crucial role, with cardiovascular disease (p = 0.001), chronic respiratory failure (p = 0.003), and chronic renal failure (p = 0.002) significantly associated with higher complication rates. However, diabetes mellitus (p = 0.109) and a history of other malignancies (p = 0.284) were not found to be statistically significant risk factors.
Surgical approach and technique had a major impact on complications. Laparoscopic procedures were linked to lower morbidity, with a complication rate of 7.1%, compared to 28% in open surgery (p = 0.003). Similarly, mechanical anastomoses demonstrated a lower complication rate (10%) compared to manual suturing (42.1%) (p = 0.009).
When analyzing surgical procedures based on tumor location, right-sided colon cancers (right hemicolectomy, transverse resection) demonstrated a lower overall complication rate compared to left-sided colorectal resections (left hemicolectomy, sigmoid resection, rectosigmoid resection, and anterior rectal resection), which are often more technically demanding. Statistical analysis confirmed that left-sided resections were significantly correlated with increased postoperative morbidity (p = 0.013). The higher complication rate in left-sided colorectal surgeries is likely due to the complexity of the procedures and the increased risk of anastomotic leakage. Based on these findings, right-sided colon surgery appears to be more favorable in terms of postoperative outcomes, as it is associated with a lower risk of complications compared to left-sided resections. This emphasizes the importance of individualized surgical planning, taking into account tumor location, disease stage, and patient-specific factors to minimize morbidity and improve recovery in colorectal cancer surgery (Table 4).

4. Discussions

Colorectal cancer remains one of the most frequently diagnosed malignancies worldwide and a leading cause of cancer-related mortality. Despite advancements in surgical techniques, perioperative management, and oncological treatments, postoperative complications remain a significant concern [32]. Factors such as tumor biology, patient comorbidities, surgical approach, and anastomotic techniques influence patient outcomes and the risk of morbidity [33]. Understanding these risk factors is essential for optimizing surgical strategies and improving postoperative recovery [34].
In our study cohort, patients with stage IV colorectal cancer exhibited a significantly higher complication rate (35.7%) compared to those with earlier-stage disease. This highlights the importance of integrating palliative care early in the treatment continuum for advanced-stage patients. Palliative care interventions, including pain management, nutritional support, and psychological counseling, play a critical role in addressing the complex challenges these patients face. Effective pain management improves comfort, sleep, mood, and overall well-being by reducing the burden of cancer-related pain. Moreover, early integration of palliative care in metastatic colorectal cancer has been shown to enhance quality of life, align treatment strategies with patient goals, and reduce unnecessary interventions and hospitalizations [35].
Our study identified high-grade tumors and stage IV disease as significant predictors of increased postoperative complications. Poorly differentiated tumors exhibited more aggressive behavior, leading to a higher risk of anastomotic failure, local recurrence, and overall surgical morbidity (p = 0.004). Similarly, patients with stage IV disease had a significantly higher complication rate compared to those with earlier-stage tumors (p = 0.001). These findings align with Gutlic et al. (2024), who reported anastomotic leakage (5.7%) and intra-abdominal infections (3.5%) as major concerns in colorectal cancer patients, particularly those with aggressive tumors [36]. Additionally, Tominaga et al. (2024) highlighted the role of tumor burden in increasing pulmonary complications, reinforcing the idea that advanced-stage disease significantly impacts postoperative morbidity and overall patient recovery [37]. These findings underscore the necessity for heightened perioperative vigilance and tailored management strategies for patients presenting with high-grade and advanced-stage colorectal cancers to mitigate the elevated risk of postoperative complications [38,39].
Patient comorbidities significantly influence postoperative outcomes in colorectal cancer surgery. Our study identified that cardiovascular disease (p = 0.001), chronic respiratory failure (p = 0.003), and chronic renal failure (p = 0.002) were associated with higher complication rates, underscoring the increased perioperative risks posed by these conditions. These findings are consistent with existing literature [37,40]. For instance, some studies have demonstrated that pre-existing chronic kidney disease correlates with elevated rates of pulmonary infections and short-term mortality following colorectal cancer surgery [41,42]. Conversely, our analysis revealed that diabetes mellitus (p = 0.109) and a history of other malignancies (p = 0.284) did not show statistically significant associations with postoperative morbidity. However, it is important to note that other studies have reported differing results. Some studies indicate that diabetes mellitus is linked to a higher incidence of postoperative complications, including anastomotic leaks and increased readmission rates [43,44,45]. These discrepancies highlight the necessity for individualized patient assessment and management, considering the complex interplay of comorbidities and their potential impact on surgical outcomes.
The choice of surgical approach remains a key factor in colorectal cancer management. Laparoscopic surgery has been widely reported to offer advantages in terms of reduced postoperative pain, shorter hospital stays, and lower complication rates compared to open surgery [46,47]. Our findings support this, as patients who underwent laparoscopic procedures had a significantly lower complication rate (7.1%) compared to those who had open surgery (28%) (p = 0.003). This aligns with Martín-Arévalo et al. (2025), who found that laparoscopic colorectal cancer surgery led to lower rates of anastomotic leakage and overall morbidity. However, their study also noted that institutional factors such as hospital workload fluctuations influenced surgical success rates, suggesting that timing and hospital capacity may indirectly affect postoperative outcomes [48]. These results reinforce the increasing preference for minimally invasive techniques when feasible, particularly for tumors amenable to laparoscopic resection.
Anastomotic technique also influenced surgical outcomes, with mechanical anastomosis demonstrating a lower complication rate (10%) compared to manual suturing (42.1%) (p = 0.009). This aligns with literature suggesting that stapled anastomoses provide more uniform tension distribution and improved healing, reducing the risk of anastomotic dehiscence [45,49]. Given that anastomotic leaks remain one of the most serious complications in colorectal surgery, the selection of a secure and reliable anastomotic technique is paramount in reducing morbidity [49,50].
Tumor location also played a role in postoperative outcomes. Right-sided colorectal surgeries were associated with a lower overall complication rate compared to left-sided resections, which demonstrated a significantly higher morbidity rate (p = 0.013). This is consistent with existing data suggesting that left-sided resections, particularly those involving the rectum and sigmoid colon, present technical challenges that increase the risk of anastomotic failure and wound-related complications [51]. The increased bacterial load in the distal colon and the narrower luminal diameter further contribute to higher complication rates in left-sided resections [52]. These variations underscore the complexity of colorectal cancer and suggest that both tumor location and patient-specific factors must be carefully considered when planning surgical interventions to optimize outcomes.
Our study found that the average hospital stay was 21 days, increasing to 33 days for patients with complications, underscoring the burden of postoperative morbidity. The overall mortality rate was 11.7%, with 6 of the 23 total deaths occurring in patients who required surgical reinterventions, resulting in a 14% mortality rate among those with complications requiring further surgery. Additionally, four patients underwent multiple reinterventions due to recurrent postoperative complications, emphasizing the impact of severe morbidity on prolonged hospital stays and increased mortality risk. In comparison, a German multicenter study involving 4146 colorectal cancer patients reported an in-hospital mortality rate of 8.7%, with higher rates observed in older patients and those with significant comorbidities [53]. Another study analyzing 129,196 colonic cancer resections found an overall in-hospital mortality rate of 5.8%, with higher mortality associated with extended colonic resections and surgeries performed in low-volume hospitals [54].
These findings highlight the complex and multifactorial nature of postoperative complications in colorectal cancer surgery, emphasizing the necessity of individualized perioperative risk assessment. Optimizing preoperative patient selection, prioritizing minimally invasive surgical techniques when feasible, and adopting mechanical anastomoses can contribute to improved outcomes by reducing surgical trauma and enhancing recovery. Additionally, proactive postoperative monitoring remains critical, especially for patients with advanced disease, significant comorbidities, or complex left-sided resections, to minimize complications and improve overall survival.

5. Limitations of the Study

This study has several limitations that should be acknowledged. First, as a retrospective study, it is inherently subject to selection bias and information bias due to its reliance on pre-existing medical records. The accuracy and completeness of data depend on the documentation quality in patient charts, which may lead to missing or incomplete variables that could influence the interpretation of risk factors. Additionally, the retrospective design limits the ability to establish causal relationships between identified risk factors and postoperative outcomes.
Second, certain clinical variables that could further refine perioperative risk assessment were not available for all patients. For example, detailed nutritional status indicators, inflammatory markers, and neoadjuvant treatment specifics were not consistently recorded, potentially affecting the assessment of prognostic factors. Moreover, variations in surgical technique, institutional practices, and perioperative care protocols across different settings may limit the generalizability of our findings.
Third, the study did not assess long-term oncological and functional outcomes, such as disease recurrence, quality of life, or bowel function postsurgery. This omission restricts the ability to evaluate the broader impact of postoperative complications beyond the immediate perioperative period. Future prospective, multicenter studies with extended follow-up periods would help validate these findings and provide more robust insights into both short- and long-term postoperative outcomes.
Despite these limitations, this study provides valuable real-world data on postoperative complications in colorectal cancer surgery. The findings reinforce the need for personalized perioperative risk stratification, optimized surgical decision making, and enhanced postoperative monitoring to improve patient outcomes.

6. Conclusions

This study highlights the multifactorial nature of postoperative complications in colorectal cancer surgery, emphasizing the impact of tumor stage, patient comorbidities, surgical approach, and anastomotic technique on patient outcomes. The findings demonstrate that high-grade tumors and advanced-stage disease are associated with an increased risk of complications, reinforcing the need for individualized perioperative strategies, particularly in high-risk patients. The lower morbidity rates observed with laparoscopic surgery support its increasing preference in colorectal cancer management, while the reduced anastomotic leakage rates associated with mechanical anastomoses further validate their role in optimizing surgical outcomes.
The prolonged hospital stay and increased mortality rate in our cohort, particularly among patients requiring surgical reinterventions, underscore the importance of early identification and management of postoperative complications. Compared to other studies, institutional factors, perioperative care variations, and differences in patient selection criteria may contribute to the observed discrepancies in outcomes, warranting further investigation. As a retrospective study, inherent limitations such as selection bias, missing clinical variables including nutritional status and inflammatory markers, and the lack of long-term oncologic and functional follow-up must be acknowledged.
Future research should focus on prospective multicenter studies incorporating standardized perioperative management protocols, enhanced recovery after surgery strategies, and long-term follow-up assessments of oncologic and functional outcomes. Further investigations into preoperative optimization, personalized risk stratification, and targeted postoperative monitoring may provide new insights to improve surgical outcomes and reduce postoperative morbidity and mortality.
Moreover, the integration of artificial intelligence and machine learning in colorectal cancer management presents promising advancements in both diagnosis and surgical decision making. AI-driven imaging and histopathological analysis can enhance early detection and staging accuracy, allowing for better risk stratification and treatment planning. Additionally, machine-learning-based predictive models can assist in identifying high-risk patients for postoperative complications, enabling personalized perioperative strategies. Future studies should explore the role of AI and machine learning in colorectal cancer surgery to develop data-driven, adaptive treatment protocols that optimize both short-term recovery and long-term survival.

Author Contributions

Conceptualization, S.S.M. and A.T.; methodology, M.Z. and P.A.R.; validation, V.S. (Victor Strambu), V.P. and D.C.; formal analysis, V.S. (Valeriu Surlin); investigation, F.P.; data curation, M.Z.; writing—original draft preparation, P.A.R. and M.B.; writing—review and editing, M.Z. and A.T.; supervision, V.S. (Victor Strambu) and D.G. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and all applicable ethical regulations. Patient confidentiality was strictly maintained, and all participants were fully informed of their right to withdraw from the study at any time without any adverse consequences. The study protocol and procedures were reviewed and approved by the Ethics Committee of the Clinical Hospital of Nephrology Carol Davila, Bucharest (Approval No. 18, issued on 17 February 2025).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data is contained within the article.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Seeto, A.H.; Nabi, H.; Burstow, M.J.; Lancashire, R.P.; Grundy, J.; Gillespie, C.; Nguyen, K.; Naidu, S.; Chua, T.C. Perioperative outcomes of emergency and elective colorectal surgery: A bi-institutional study. ANZ J. Surg. 2023, 93, 926–931. [Google Scholar] [CrossRef] [PubMed]
  2. Shinji, S.; Yamada, T.; Matsuda, A.; Sonoda, H.; Ohta, R.; Iwai, T.; Takeda, K.; Yonaga, K.; Masuda, Y.; Yoshida, H. Recent Advances in the Treatment of Colorectal Cancer: A Review. J. Nippon. Med. Sch. 2022, 89, 246–254. [Google Scholar] [CrossRef] [PubMed]
  3. Selvamani, T.Y.; Shoukrie, S.I.; Malla, J.; Venugopal, S.; Selvaraj, R.; Dhanoa, R.K.; Zahra, A.; Hamouda, R.K.; Raman, A.; Mostafa, J. Predictors That Identify Complications Such As Anastomotic Leak in Colorectal Surgery: A Systematic Review. Cureus 2022, 14, e28894. [Google Scholar] [CrossRef]
  4. Radu, P.; Zurzu, M.; Tigora, A.; Paic, V.; Bratucu, M.; Garofil, D.; Surlin, V.; Munteanu, A.C.; Coman, I.S.; Popa, F.; et al. The Impact of Cancer Stem Cells in Colorectal Cancer. Int. J. Mol. Sci. 2024, 25, 4140. [Google Scholar] [CrossRef]
  5. Baidoun, F.; Elshiwy, K.; Elkeraie, Y.; Merjaneh, Z.; Khoudari, G.; Sarmini, M.T.; Gad, M.; Al-Husseini, M.; Saad, A. Colorectal Cancer Epidemiology: Recent Trends and Impact on Outcomes. Curr. Drug Targets 2021, 22, 998–1009. [Google Scholar] [CrossRef]
  6. Siegel, R.L.; Miller, K.D.; Sauer, A.G.; Fedewa, S.A.; Butterly, L.F.; Anderson, J.C.; Cercek, A.; Smith, R.A.; Jemal, A. Colorectal cancer statistics, 2020. CA Cancer J. Clin. 2020, 70, 145–164. [Google Scholar] [CrossRef] [PubMed]
  7. Patrascu, S.; Cercelaru, L.; Graure, G.M.; Firut, M.A.; Rotaru, I.; Cartu, D.; Marinescu, D.; Patrascu, A.M.; Radu, R.I.; Mitroi, G.; et al. The histopathological features and their prognostic impact in the postoperative follow-up of colorectal cancer patients. Rom. J. Morphol. Embryol. 2022, 63, 555–561. [Google Scholar] [CrossRef]
  8. Karam, F.; El Deghel, Y.; Iratni, R.; Dakroub, A.H.; Eid, A.H. The Gut Microbiome and Colorectal Cancer: An Integrative Review of the Underlying Mechanisms. Cell Biochem. Biophys. 2025. [Google Scholar] [CrossRef]
  9. Krynicka, P.; Koulaouzidis, G.; Skonieczna-Zydecka, K.; Marlicz, W.; Koulaouzidis, A. Application of Raman Spectroscopy in Non-Invasive Analysis of the Gut Microbiota and Its Impact on Gastrointestinal Health. Diagnostics 2025, 15, 292. [Google Scholar] [CrossRef]
  10. Singh, V.; Shirbhate, E.; Kore, R.; Vishwakarma, S.; Parveen, S.; Veerasamy, R.; Tiwari, A.K.; Rajak, H. Microbial Metabolites-induced Epigenetic Modifications for Inhibition of Colorectal Cancer: Current Status and Future Perspectives. Mini Rev. Med. Chem. 2025, 25, 76–93. [Google Scholar] [CrossRef]
  11. Zheng, Z.; Hu, Y.; Tang, J.; Xu, W.; Zhu, W.; Zhang, W. The implication of gut microbiota in recovery from gastrointestinal surgery. Front. Cell. Infect. Microbiol. 2023, 13, 1110787. [Google Scholar] [CrossRef]
  12. Agnes, A.; Puccioni, C.; D′Ugo, D.; Gasbarrini, A.; Biondi, A.; Persiani, R. The gut microbiota and colorectal surgery outcomes: Facts or hype? A narrative review. BMC Surg. 2021, 21, 83. [Google Scholar] [CrossRef] [PubMed]
  13. Nalluri-Butz, H.; Bobel, M.C.; Nugent, J.; Boatman, S.; Emanuelson, R.; Melton-Meaux, G.; Gaertner, W.B. A pilot study demonstrating the impact of surgical bowel preparation on intestinal microbiota composition following colon and rectal surgery. Sci. Rep. 2022, 12, 10559. [Google Scholar] [CrossRef]
  14. Puzzo, M.; De Santo, M.; Morelli, C.; Leggio, A.; Catalano, S.; Pasqua, L. Colorectal Cancer: Current and Future Therapeutic Approaches and Related Technologies Addressing Multidrug Strategies Against Multiple Level Resistance Mechanisms. Int. J. Mol. Sci. 2025, 26, 1313. [Google Scholar] [CrossRef] [PubMed]
  15. Selvaraj, V.; Sudhakar, S.; Sekaran, S.; Rameshkumar, N.; Krishnan, M.; Sekar, S.K.R. Cutting-edge nanotechnology transforming cancer surgery and recovery. Int. J. Surg. 2024, 110, 8207–8209. [Google Scholar] [CrossRef] [PubMed]
  16. Lee, J.; Cho, Y.; Kyung, Y.; Kim, E. Precision Forecasting in Colorectal Oncology: Predicting Six-Month Survival to Optimize Clinical Decisions. Electronics 2025, 14, 880. [Google Scholar] [CrossRef]
  17. Sullo, F.G.; Passardi, A.; Gallio, C.; Molinari, C.; Marisi, G.; Pozzi, E.; Solaini, L.; Bittoni, A. Advancing Personalized Medicine in the Treatment of Locally Advanced Rectal Cancer. J. Clin. Med. 2024, 13, 2562. [Google Scholar] [CrossRef]
  18. Coco, C.; Rizzo, G.; Amodio, L.E.; Pafundi, D.P.; Marzi, F.; Tondolo, V. Current Management of Locally Recurrent Rectal Cancer. Cancers 2024, 16, 3906. [Google Scholar] [CrossRef]
  19. Ramadan, B.; Dahboul, H.; Mouawad, C.; Aoun, R.; Kassar, S.; Kassouf, E.; Chakhtoura, G.; Noun, R.; Osseis, M. Obesity: A risk factor for postoperative complications in laparoscopic surgery for colorectal cancer. J. Minimal Access Surg. 2024, 20, 12–18. [Google Scholar] [CrossRef]
  20. Strâmbu, V.; Garofil, D.; Pop, F.; Radu, P.; Bratucu, M.; Iorga, C.; Iorga, R.; Pasnicu, C.; Ion, A.; Popa, F. Microsatellite instability in the management of stage II colorectal patients. Chirurgia 2013, 108, 816–821. [Google Scholar]
  21. Tsalikidis, C.; Mitsala, A.; Mentonis, V.I.; Romanidis, K.; Pappas-Gogos, G.; Tsaroucha, A.K.; Pitiakoudis, M. Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going? Curr. Oncol. 2023, 30, 3111–3137. [Google Scholar] [CrossRef]
  22. Zhao, Y.; Li, B.; Sun, Y.; Liu, Q.; Cao, Q.; Li, T.; Li, J. Risk Factors and Preventive Measures for Anastomotic Leak in Colorectal Cancer. Technol. Cancer Res. Treat. 2022, 21. [Google Scholar] [CrossRef] [PubMed]
  23. He, J.; He, M.; Tang, J.H.; Wang, X.H. Anastomotic leak risk factors following colon cancer resection: A systematic review and meta-analysis. Langenbeck’s Arch. Surg. 2023, 408, 252. [Google Scholar] [CrossRef] [PubMed]
  24. Li, H.; Luo, T.F.; Zhang, N.R.; Zhang, L.Z.; Huang, X.; Jin, S.Q. Factors associated with prolonged postoperative length of hospital stay after laparoscopic colorectal cancer resection: A secondary analysis of a randomized controlled trial. BMC Surg. 2022, 22, 438. [Google Scholar] [CrossRef]
  25. Miles, L.F.; Luu, S.; Ong, I.; Soo, V.P.; Braat, S.; Burgess, A.; Heritier, S.; Tan, N.; Parker, A.; Richards, T.; et al. Associations between non-anaemic iron deficiency and outcomes following elective surgery for colorectal cancer: A prospective cohort study. Anaesthesia 2025, 80, 48–58. [Google Scholar] [CrossRef]
  26. Herlo, L.F.; Golu, I.; Herlo, A.; Virzob, C.R.B.; Alin, I.; Iurciuc, S.; Iordache, I.E.; Alexandrescu, L.; Tofolean, D.E.; Dumache, R. Impact of Preoperative and Intraoperative Factors on Postoperative Outcomes in Patients with Colorectal Cancer: A 10-Year Retrospective Study. Diseases 2025, 13, 16. [Google Scholar] [CrossRef] [PubMed]
  27. Zindani, S.; Khalil, M.; Woldesenbet, S.; Rashid, Z.; Altaf, A.; Kawashima, J.; Schenk, A.; Pawlik, T.M. Impact of Disability on Postoperative Outcomes After Gastrointestinal Cancer Surgery. Ann. Surg. Oncol. 2025, 32, 3352–3359. [Google Scholar] [CrossRef]
  28. Lopez, J.E.M.; Ponce, A.J.M.; Sánchez, A.Y.F.; Miranda, D.J.C.; Alava, R.R.O.; Silva, A.D.; Moreno, J.D.N.; Hernández, K.S. Advances in minimally invasive surgical techniques for the management of enterocutaneous fistula: A systematic review of clinical and postoperative outcomes. Int. J. Res. Med. Sci. 2025, 13, 9. [Google Scholar] [CrossRef]
  29. Lim, J.S.; Brant, N.; Downs, J.M.; Apple, W.; Stadler, R.; Jeyarajah, D.R. Minimally Invasive Lower Anterior Resections-Better than Open But Not All the Same. Am. Surg. 2023, 89, 5270–5275. [Google Scholar] [CrossRef]
  30. Ri, H.; Kang, H.; Xu, Z.; Kim, K.; Ren, Y.; Gong, Z.; Chen, X. The risk factors of low anterior resection syndrome after colorectal cancer surgery: A retrospective study of 566 patients in a single institution in China. Front. Surg. 2022, 9, 990702. [Google Scholar] [CrossRef]
  31. Dilke, S.M.; Hadjittofi, C.; Than, M.; Tozer, P.J.; Stearns, A.T. Anterior Resection Syndrome and Quality of Life With Long-term Follow-up After Rectal Cancer Resection. Dis. Colon Rectum 2022, 65, 1251–1263. [Google Scholar] [CrossRef] [PubMed]
  32. Bagheri, R.; Ghorbian, M.; Ghorbian, S. Tumor circulating biomarkers in colorectal cancer. Cancer Treat. Res. Commun. 2024, 38, 100787. [Google Scholar] [CrossRef] [PubMed]
  33. Marcellinaro, R.; Spoletini, D.; Grieco, M.; Avella, P.; Cappuccio, M.; Troiano, R.; Lisi, G.; Garbarino, G.M.; Carlini, M. Colorectal Cancer: Current Updates and Future Perspectives. J. Clin. Med. 2023, 13, 40. [Google Scholar] [CrossRef] [PubMed]
  34. Abedizadeh, R.; Majidi, F.; Khorasani, H.R.; Abedi, H.; Sabour, D. Colorectal cancer: A comprehensive review of carcinogenesis, diagnosis, and novel strategies for classified treatments. Cancer Metastasis Rev. 2024, 43, 729–753. [Google Scholar] [CrossRef]
  35. Piqeur, F.; Coolen, L.; Nordkamp, S.; Creemers, D.M.J.; Tijssen, R.H.N.; Neggers-Habraken, A.G.J.; Rutten, H.J.T.; Nederend, J.; Marijnen, C.A.M.; Burger, J.W.A.; et al. Analysis of re-recurrent rectal cancer after curative treatment of locally recurrent rectal cancer. Radiother. Oncol. 2024, 200, 110520. [Google Scholar] [CrossRef]
  36. Gutlic, I.; Saraste, D.; Nordenvall, C.; Martling, A.; Lydrup, M.L.; Buchwald, P. Postoperative complications and emergency surgeries in colorectal cancer patients <50 years—A national cohort study. Color. Dis. 2024, 26, 1397–1404. [Google Scholar] [CrossRef]
  37. Tominaga, T.; Nonaka, T.; Takamura, Y.; Oishi, K.; Hashimoto, S.; Shiraishi, T.; Noda, K.; Ono, R.; Ishii, M.; Hisanaga, M.; et al. Risk factors for pulmonary complications after colorectal cancer surgery: A Japanese multicenter study. Int. J. Color. Dis. 2024, 39, 76. [Google Scholar] [CrossRef]
  38. Oishi, K.; Tominaga, T.; Ono, R.; Noda, K.; Hashimoto, S.; Shiraishi, T.; Takamura, Y.; Nonaka, T.; Ishii, M.; Fukuoka, H.; et al. Risk factors for reoperation within 30 days in laparoscopic colorectal cancer surgery: A Japanese multicenter study. Asian J. Endosc. Surg. 2024, 17, e13257. [Google Scholar] [CrossRef]
  39. Yu, G.; Wei, R.; Liu, H.; Liu, Y.; Guan, X.; Wang, X.; Jiang, Z. Prognostic model for predicting the survival benefit of adjuvant chemotherapy for elderly patients with stage II colon cancer: A population-based study. Eur. J. Cancer Prev. 2024, 33, 105–114. [Google Scholar] [CrossRef]
  40. Liu, X.R.; Liu, F.; Li, Z.W.; Liu, X.Y.; Zhang, W.; Peng, D. The risk of postoperative complications is higher in stage I-III colorectal cancer patients with previous abdominal surgery: A propensity score matching analysis. Clin. Transl. Oncol. 2023, 25, 3471–3478. [Google Scholar] [CrossRef]
  41. Qu, S.P.; Rao, S.Q.; Hai, Z.X.; Wang, C.Y. Does chronic kidney disease affect the short-term outcomes and prognosis of colorectal cancer surgery? A propensity score matching analysis. Front. Oncol. 2024, 14, 1400313. [Google Scholar] [CrossRef] [PubMed]
  42. Liu, X.Y.; Zhang, B.; Cheng, Y.X.; Tao, W.; Yuan, C.; Wei, Z.Q.; Peng, D. Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery? World J. Gastrointest. Oncol. 2022, 14, 1199–1209. [Google Scholar] [CrossRef] [PubMed]
  43. Tan, D.J.H.; Yaow, C.Y.L.; Mok, H.T.; Ng, C.H.; Tai, C.H.; Tham, H.Y.; Foo, F.J.; Chong, C.S. The influence of diabetes on postoperative complications following colorectal surgery. Tech. Coloproctology 2021, 25, 267–278. [Google Scholar] [CrossRef]
  44. Popescu, R.C.; Leopa, N.; Dumitru, E.; Mitroi, A.F.; Tocia, C.; Dumitru, A.; Brinzan, C.; Botea, F. Influence of type II diabetes mellitus on postoperative complications following colorectal cancer surgery. Exp. Ther. Med. 2022, 24, 611. [Google Scholar] [CrossRef]
  45. Bisset, C.N.; Moug, S.J.; Oliphant, R.; Dames, N.; Parson, S.; Cleland, J. Influencing factors in surgical decision-making: A qualitative analysis of colorectal surgeons’ experiences of postoperative complications. Color. Dis. 2024, 26, 987–993. [Google Scholar] [CrossRef]
  46. Nakajo, S.; Uemura, M.; Sekido, Y.; Hata, T.; Hamabe, A.; Ogino, T.; Miyoshi, N.; Yamamoto, H.; Doki, Y.; Eguchi, H. Laparoscopic Colorectal Cancer Surgery for Patients With Severe Chronic Heart Failure. Anticancer Res. 2023, 43, 5645–5648. [Google Scholar] [CrossRef] [PubMed]
  47. Ishiyama, Y.; Tachimori, Y.; Harada, T.; Mochizuki, I.; Tomizawa, Y.; Ito, S.; Oneyama, M.; Amiki, M.; Hara, Y.; Narita, K.; et al. Oncologic outcomes after laparoscopic versus open multivisceral resection for local advanced colorectal cancer: A meta-analysis. Asian J. Surg. 2023, 46, 6–12. [Google Scholar] [CrossRef]
  48. Martin-Arevalo, J.; Moro-Valdezate, D.; Garcia-Botello, S.; Perez-Santiago, L.; Casado-Rodrigo, D.; Garzon-Hernandez, L.P.; Castillejos-Ibanez, F.; Sanchez-Lara, J.S.; Martinez-Ciarpaglini, C.; Pla-Marti, V. Seasonal and cyclical variations in short-term postoperative outcomes of colorectal cancer: A time series analysis. Sci. Rep. 2025, 15, 5161. [Google Scholar] [CrossRef]
  49. Shibutani, M.; Fukuoka, T.; Iseki, Y.; Kasashima, H.; Kitayama, K.; Maeda, K. Impact of a circular powered stapler on preventing anastomotic leakage in patients with left-sided colorectal cancer: A retrospective study. BMC Surg. 2023, 23, 205. [Google Scholar] [CrossRef]
  50. Rennie, O.; Sharma, M.; Helwa, N. Colorectal anastomotic leakage: A narrative review of definitions, grading systems, and consequences of leaks. Front. Surg. 2024, 11, 1371567. [Google Scholar] [CrossRef]
  51. Wismayer, R.; Kiwanuka, J.; Wabinga, H.; Odida, M. Colorectal adenocarcinoma in Uganda: Are right-sided and left-sided colon cancers two distinct disease entities? World J. Surg. Oncol. 2023, 21, 215. [Google Scholar] [CrossRef] [PubMed]
  52. Fernandez, I.M.; Velasco, S.M.; Luque, J.D.T.; Poveda, I.G.; Lopez, M.R.; Santoyo, J.S. Right and Left Colorectal Cancer: Differences in Post-Surgical-Care Outcomes and Survival in Elderly Patients. Cancers 2021, 13, 2647. [Google Scholar] [CrossRef] [PubMed]
  53. Kostev, K.; Krieg, S.; Krieg, A.; Luedde, T.; Loosen, S.H.; Roderburg, C. In-Hospital Mortality and Associated Factors among Colorectal Cancer Patients in Germany. Cancers 2024, 16, 1219. [Google Scholar] [CrossRef] [PubMed]
  54. Diers, J.; Wagner, J.; Baum, P.; Lichthardt, S.; Kastner, C.; Matthes, N.; Lob, S.; Matthes, H.; Germer, C.T.; Wiegering, A. Nationwide in-hospital mortality following colonic cancer resection according to hospital volume in Germany. BJS Open 2019, 3, 672–677. [Google Scholar] [CrossRef]
Table 1. Clinicopathological Data.
Table 1. Clinicopathological Data.
ParameterTotal (n = 195)Percentage (%)
Age (Mean ± SD)66 ± 12 years
Sex
Male11961.0%
Female7639.0%
Comorbidities
Cardiovascular Disease11760.0%
Chronic Respiratory Failure3116.0%
Chronic Renal Failure178.7%
Diabetes Mellitus105.3%
History of Other Malignancies168.2%
Type of Cancer
Adenocarcinoma18293.3%
Mucinous Adenocarcinoma105.1%
Other Types31.6%
Tumor Location
Right Colon3316.9%
Left Colon199.7%
Rectosigmoid189.2%
Rectum5528.2%
Histological Grade
Low–Intermediate7035.9%
High12564.1%
Anastomotic Technique
Manual Suturing94.6%
Linear Stapler4322.1%
Circular Stapler9347.7%
Table 2. Surgical procedures.
Table 2. Surgical procedures.
Surgical ProcedureNumber of PatientsPercentage (%)
Right Hemicolectomy2412.3
Left Hemicolectomy199.7
Sigmoid Resection3316.9
Rectosigmoid Resection189.2
Anterior Rectal Resection3920.0
Rectal Extirpation168.2
Hartmann’s Procedure105.1
Stoma Confection157.7
Hartmann’s Reversal94.6
Transverse Resection94.6
Other Procedures31.5
Table 3. Postoperative complications.
Table 3. Postoperative complications.
ComplicationCases (n)Percentage (%)
Total Postoperative Complications4121.0
Wound Healing Disorders115.6
Bleeding115.6
Subcutaneous Hematoma21.0
Lower Gastrointestinal Bleeding52.6
Hemoperitoneum42.0
Anastomotic Leaks168.2
Stercoral Peritonitis105.1
Entero-Cutaneous Fistulas21.0
Low-Flow Anastomotic Dehiscence42.0
Evisceration31.5
Other Complications63.1
Uroperitoneum21.0
Intraperitoneal Abscess31.5
Table 4. Comparative analysis of factors influencing postoperative complications in colorectal cancer surgery.
Table 4. Comparative analysis of factors influencing postoperative complications in colorectal cancer surgery.
FactorComparison GroupsComplication Ratep-Value
Tumor GradeLow–Intermediate vs. HighHigher in high-grade tumors.0.004
Tumor StageStage I–III vs. Stage IVHigher in stage IV.0.001
ComorbiditiesCardiovascular DiseasePatients with cardiovascular disease have a significantly higher risk of complications.0.001
Chronic Respiratory FailureChronic respiratory failure significantly increases perioperative risks.0.003
Chronic Renal FailureChronic kidney disease is significantly correlated with a higher complication rate.0.002
Diabetes MellitusNo statistically significant association between diabetes and postoperative complications.0.109
History of Other MalignanciesNo significant association between prior malignancies and complications.0.284
Surgical ApproachLaparoscopic vs. OpenLaparoscopic surgery significantly reduces the complication rate compared to open surgery.0.003
Anastomotic TechniqueMechanical vs. ManualMechanical anastomosis is associated with a significantly lower risk of complications than manual suturing.0.009
Tumor LocationRight vs. Left ColonLeft-sided tumors have a significantly higher complication rate compared to right-sided tumors.0.013
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Marginean, S.S.; Zurzu, M.; Garofil, D.; Tigora, A.; Paic, V.; Bratucu, M.; Popa, F.; Surlin, V.; Cartu, D.; Strambu, V.; et al. Evaluation of Key Risk Factors Associated with Postoperative Complications in Colorectal Cancer Surgery. J. Mind Med. Sci. 2025, 12, 22. https://doi.org/10.3390/jmms12010022

AMA Style

Marginean SS, Zurzu M, Garofil D, Tigora A, Paic V, Bratucu M, Popa F, Surlin V, Cartu D, Strambu V, et al. Evaluation of Key Risk Factors Associated with Postoperative Complications in Colorectal Cancer Surgery. Journal of Mind and Medical Sciences. 2025; 12(1):22. https://doi.org/10.3390/jmms12010022

Chicago/Turabian Style

Marginean, Silviu Stefan, Mihai Zurzu, Dragos Garofil, Anca Tigora, Vlad Paic, Mircea Bratucu, Florian Popa, Valeriu Surlin, Dan Cartu, Victor Strambu, and et al. 2025. "Evaluation of Key Risk Factors Associated with Postoperative Complications in Colorectal Cancer Surgery" Journal of Mind and Medical Sciences 12, no. 1: 22. https://doi.org/10.3390/jmms12010022

APA Style

Marginean, S. S., Zurzu, M., Garofil, D., Tigora, A., Paic, V., Bratucu, M., Popa, F., Surlin, V., Cartu, D., Strambu, V., & Radu, P. A. (2025). Evaluation of Key Risk Factors Associated with Postoperative Complications in Colorectal Cancer Surgery. Journal of Mind and Medical Sciences, 12(1), 22. https://doi.org/10.3390/jmms12010022

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