A number of factors can impair disease-free survival following surgery and may include: Insulin resistance with hyperinsulinemia in diabetics, hyperglycemia leading to abnormal growth regulation, poor nutritional status leading to treatment alterations in decrease delivery of chemotherapy and/or radiotherapy and anastomotic leakage, excessive weight loss, and delayed recovery from surgery (V. Satya Suresh Attili).
Compared to patients without in GI malignancies the risk of relapse is 9.8 times grade in patients with anastomotic leak, 8.2 times grade in those with delayed recovery and 2.3 times grade in those with weight loss (V. Satya Suresh Attili).
Anastomotic leakage leads to poorer disease-free survival and pancreas cancer stomach cancer in other GI malignancies.