Preoperative CT Evaluation of Abdominal Vasculature and the Risk of Surgical Complications in Colorectal Cancer Resection with Anastomosis: A Systematic Review and Meta-Analysis

Background: Preoperative CT is part of the routine diagnostic work-up for colorectal cancer (CRC), and CT-based biomarkers have been linked to oncological and surgical outcomes in CRC patients. This review aims to evaluate the association between preoperative CT-derived vascular disease markers (calcification and stenosis) and postoperative outcomes after curative CRC resection with anastomosis. Methods: Following PRISMA, we conducted a systematic review and meta-analysis of studies identified from MEDLINE/PubMed, Embase, Web of Science Core Collection and Google Scholar from inception until 1st of January 2026, with the protocol registered in PROSPERO (CRD420251248044). Eligible studies examined CT-derived abdominal vascular disease markers in CRC patients treated with curative resection and anastomosis and reported postoperative outcomes (anastomotic leakage (AL) grade C, major morbidity, and mortality). Risk of bias was assessed using the Newcastle–Ottawa Scale. We pooled odds ratios using random-effects models when ≥3 studies reported comparable exposure–outcome comparisons. Results: Fourteen studies (6712 participants) were included, and 12 contributed to quantitative synthesis. Higher calcification burden was associated with increased odds of any AL (OR 3.08, 95% CI 2.09–4.54; k = 11; n = 5005) and severe/grade C AL (OR 2.68, 95% CI 1.03–6.97; k = 3; n = 3418). Evidence for major morbidity was imprecise (OR 1.99, 95% CI 0.86–4.59; k = 3; n = 841), and data for mesenteric stenosis outcomes and mortality were limited. Sensitivity analyses indicate attenuation without loss of significance after trim-and-fill (adjusted OR 2.39) and that non-ROC cut points yield a smaller effect size (OR 2.42). Conclusions: CT-derived vascular disease markers are associated with higher odds of AL after CRC surgery. Prospective studies should standardize methods and test clinical utility.