Does Red Cell Distribution Width Have a Predictive Role in Anastomotic Leak after Right Hemicolectomy for Colon Cancer?

Introduction: Red cell distribution width (RDW) has recently emerged as a potential biomarker reflecting nutritional and inflammatory status in surgical oncology. While anastomotic leakage (AL) remains a devastating complication after right hemicolectomy for colorectal cancer, the predictive role of RDW in this setting has not been clearly established. This study aimed to evaluate the prognostic significance of RDW in predicting AL and postoperative outcomes after right hemicolectomy. Methods: This retrospective study included 234 patients who underwent right or extended right hemicolectomy for colorectal cancer between June 2020 and May 2025 at a tertiary referral center. Demographic, surgical, histopathological, and laboratory data were analyzed. Postoperative complications were graded according to the Clavien–Dindo classification. Results: AL occurred in 3.4% of patients; however, RDW was not an independent predictor. Patients with elevated RDW-fL values (>46.1 fL) were significantly older and had higher American Society of Anesthesiologists’ (ASA) scores, lower preoperative hemoglobin and albumin levels, and higher C-reactive protein levels. They also demonstrated shorter overall survival (47.7 versus 59.2 months, P = .027). High RDW-fL was independently associated with major postoperative complications and failure to complete adjuvant therapy. Conclusion: Preoperative RDW did not predict AL but was strongly associated with postoperative complications, adverse survival, and incomplete adjuvant treatment. RDW may serve as a simple, cost-effective biomarker for perioperative risk stratification in colorectal cancer surgery.