Young adults undergoing anterior resection for colorectal cancer experience fewer medical complications but a comparable risk of anastomotic leak.

Abstract

The incidence of colorectal cancer in adults <50 years old is rising, yet data to guide preoperative counselling of younger patients are limited. We hypothesized that younger adults have lower rates of anastomotic leak after anterior resection than that of older adults. Adults undergoing elective anterior resection for nonmetastatic colorectal cancer were identified from the American College of Surgeons National Surgical Quality Improvement Program (2012-2023) and stratified by age (<50 vs ≥50 years). Multivariable analyses evaluated associations between age and postoperative outcomes, including anastomotic leak, reoperation, and respiratory and renal complications. Of 42,633 patients, 7213 (16.9%) were <50 years. Younger patients had lower rates of diabetes (7.0 vs. 19.3%, p < 0.001) but were more often obese (17.7 vs. 14.5%, p < 0.001) and diagnosed with rectal cancer (46.2 vs. 39.8%, p < 0.001). On univariate analysis, younger patients had similar leak rates compared with older patients (3.4 vs. 3.5%, p = 0.70) but fewer respiratory (0.7 vs. 2.2%, p < 0.001) and renal (0.9 vs. 2.3%, p < 0.001) complications. On multivariable analysis, younger age was not associated with risk of leak (OR = 1.05, p = 0.54) or reoperation (OR = 0.92, p = 0.21) but was protective against respiratory (OR = 0.40, p < 0.001) and renal (OR = 0.48, p < 0.001) complications. Protective factors against leak included faecal diversion (OR = 0.87, p = 0.03), female sex (OR = 0.61, p < 0.001), laparoscopic approach (OR = 0.75, p < 0.001), preoperative antibiotics (OR = 0.63, p < 0.001) and nonsmoking status (OR = 0.69, p < 0.001). Younger colorectal cancer patients had fewer comorbidities and medical complications but similar anastomotic leak and reoperation rates compared to older adults, highlighting the importance of preoperative counselling to guide patient expectations.