EPD406 - Simultaneous Colectomy and Hepatectomy for Metastatic Colorectal Cancer is Associated With Increased Risk of Anastomotic Leak

Monday, May 11, 2026

1:58 PM - 2:03 PM ET

ePoster of Distinction Presenter(s)

Sarah E. Rudasill, MD (she/her/hers)

General Surgery Resident
Massachusetts General Hospital
Massachusetts General Hospital
Anacortes, WA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

HB

Hannah Bank, MD PhD

Surgery resident
MGH
Boston, Massachusetts, United States

Disclosure information not submitted.
Rebecca Tang, MD

General Surgery Resident
Massachusetts General Hospital
Boston, MA, United States

Disclosure information not submitted.
JM

Jessica L. Mueller, MD

General Surgery Resident
Massachusetts General Hospital
Boston, Massachusetts, United States

Disclosure information not submitted.
HK

Hiroko Kunitake, MD MPH

Associate Professor
Harvard Medical School, Massachusetts General Hospital
Harvard Medical School, Massachusetts General Hospital
Boston, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Rocco R. Ricciardi, MD

Chief, Division of Colon & Rectal Surgery
Massachusetts General Hospital
Harvard University
Boston, MA, United States

Disclosure information not submitted.
MQ

Motaz Qadan, MD PhD

Surgeon-in-Chief, Mass General Brigham Cancer Institute
Massachusetts General Hospital
Boston, Massachusetts, United States

Disclosure information not submitted.

Senior Author(s)

Grace C. Lee, MD

Assistant Professor of Surgery
Massachusetts General Hospital
Harvard Medical School
Boston, MA, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Sarah E. Rudasill, MD: This individual has no financial relationships with ineligible companies.

Hiroko Kunitake, MD MPH: This individual has no financial relationships with ineligible companies.

Purpose/Background: Synchronous liver metastases are found in up to 50% of patients with newly diagnosed colorectal cancer, and resection of all tumor sites offers the only chance of cure. However, the optimal timing of colectomy and hepatectomy, whether simultaneous or staged, remains controversial. We hypothesized that simultaneous resection is associated with an increased risk of anastomotic leak.

Methods/Interventions: We performed a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program's colectomy database (2012-2023). Adults with colorectal cancer undergoing right colectomy, low anterior resection (LAR), or partial colectomy were stratified into three groups: colectomy alone, colectomy with partial (non-anatomic) hepatectomy, or colectomy with anatomic hepatectomy (left, right, and trisegmentectomy). Nonelective procedures and fecal diversion were excluded. The primary outcome was anastomotic leak. Secondary outcomes included leaks requiring intervention, organ space infections, postoperative transfusion, and reoperation. Continuous and categorical variables were analyzed with Kruskal-Wallis and chi-squared tests, respectively. Multivariable logistic regressions evaluated outcome associations.

Results/Outcomes: Among 127,091 patients, 869 (0.6%) underwent concurrent partial and 161 (0.1%) anatomic hepatectomy. Compared with colectomy alone, patients undergoing any hepatectomy were younger (58.7 vs. 65.7 years, p< 0.001) and more often received preoperative chemotherapy within 90 days of surgery (54.7% vs. 6.1%, p< 0.001). On univariate analysis, anastomotic leak rates increased stepwise with extent of hepatectomy (2.6% colectomy alone vs. 5.0% partial hepatectomy vs. 8.1% anatomic hepatectomy, p< 0.001), as did leaks requiring intervention (2.0% vs. 4.4% vs. 7.5%, p< 0.001), organ space infections (3.2% vs. 11.2% vs. 13.0%, p< 0.001), and transfusion rates (6.9% vs. 15.5% vs. 26.1%, p< 0.001).

On multivariable analysis controlling for baseline characteristics and operative time, both partial (OR=1.38, p=0.045) and anatomic (OR=2.27, p=0.01) hepatectomy were associated with an increased risk of anastomotic leak compared to colectomy alone. Additional risk factors for anastomotic leak included male sex (OR=1.55, p< 0.001); LAR (OR=1.21, p< 0.001) or partial colectomy (OR=1.11, p=0.02) relative to right colectomy; rectal cancer (OR=1.60, p< 0.001) relative to colon cancer; body mass index >35kg/m2 (OR=1.17, p=0.001); and current tobacco use (OR=1.56, p< 0.001). Protective factors included a minimally invasive approach (OR=0.67, p< 0.001) and mechanical (OR=0.83, p< 0.001) or antibiotic (OR=0.77, p< 0.001) bowel preparation. Partial and anatomic hepatectomy were also associated with higher rates of leaks requiring intervention (OR=1.57; p=0.01 and OR=2.71; p=0.001), organ space infections (OR=2.24 and OR=2.25, both p< 0.001) and transfusion rates (OR=1.56 and OR=3.02, both p< 0.001), but not reoperation (OR=1.04; p=0.83 and OR=1.22; p=0.56).

Conclusion/Discussion: Simultaneous colectomy and hepatectomy for metastatic colorectal cancer is associated with a "dose-dependent" increase in the risk of anastomotic leak with greater extent of liver resection. Careful patient selection is particularly important for those at higher risk of leak, including men, patients with obesity or tobacco use, and those undergoing LAR for rectal cancer. These patients may benefit from staged procedures, especially when anatomic hepatectomy is planned.

Table 1. Multivariable regression for predictors of anastomotic leak in patients with colorectal cancer