POSTOPER ATIVE COMPLICATIONS AFTER COLORECTAL CANCER SURGERY: RISK FACTORS, IMPACT ON SURVIVAL, AND CONTEMPORARY PREVENTION STRATEGIES (A LITERATURE REVIEW)

Abstract

Relevance: Postoperative complications remain major determinants of unfavorable outcomes following colorectal cancer surgery, contributing to increased mortality, reoperation rates, disease recurrence, and reduced long-term survival.The study aimed to analyze current evidence on postoperative complications after colorectal cancer surgery, identify major risk factors, evaluate their impact on long-term survival, and summarize contemporary preventive strategies.Materials and Methods: This structured literature review covered 39 publications from January 1, 2021, through July 31, 2026, including 34 original studies and 4 systematic reviews or meta-analyses; the GLOBOCAN 2022 fact sheet was used only for epidemiological context and was not counted among the included studies.Results: Reported overall postoperative morbidity ranged from 8.1% to 33.3%, while colorectal anastomotic leakage occurred in 4.7% to 15.1% of patients. Wen et al. reported postoperative infectious complications in 95/593 patients (16.0%), including wound infection, anastomotic leakage, intra-abdominal infection, pneumonia, and other infectious events. Severe complications (Clavien-Dindo grades III-V) occurred in 9.7-29.7% of patients. Significant adjusted associations included sarcopenia and postoperative complications (OR = 2.53; 95% CI: 1.45-4.42), three or more linear stapler firings and anastomotic leakage (OR = 2.71; 95% CI: 1.17-6.26), and male sex in a CT-based leakage model (OR = 3.75). In one colon cancer cohort, postoperative complications were associated with a higher adjusted risk of death (HR = 1.70; 95% CI: 1.19-2.45). Multimodal prehabilitation reduced major complications from 29.7% to 17.1%, while diverting ileostomy was associated with fewer leakage-related reoperations.Conclusion: Postoperative complications are consistently associated with adverse short- and long-term outcomes following colorectal cancer surgery. Adjusted analyses identify nutritional, metabolic, patient-related, and technical factors that may support risk stratification. Multimodal prehabilitation, nutritional optimization, structured perioperative pathways, meticulous anastomotic technique, and selective diversion may reduce postoperative morbidity; however, the predominantly observational and heterogeneous evidence does not establish causality.