Abstract
<title>Abstract</title> <p> <bold>Purpose:</bold> preoperative nutritional status may negatively influence the risk of anastomotic fistula (AF), a severe complication occurring after surgery for colorectal cancer (CRC). The FourColon-Factors study, approved by the Ethics Committee of the Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, Naples (Prot. n. 70/24 OSS, November 27, 2024), aims to evaluate the prognostic role of malnutrition risk on AF in retrospective and prospective cohorts of patients with a primary diagnosis of CRC. Secondary outcomes include Health-Related Quality of Life (HRQoL) in the prospective cohort and overall survival (OS) in the retrospective cohort. <bold>Methods:</bold> a total of 268 patients with a primary diagnosis of CRC eligible for surgery will be enrolled at the Istituto Nazionale Tumori IRCCS – Fondazione G. Pascale, Naples. In the prospective cohort, preoperative nutritional status will be assessed using validated screening tools, anthropometric measurements, handgrip strength test, and serum biomarkers. Body composition will be evaluated using bioelectrical impedance analysis, while HRQoL using a validated, cancer-specific questionnaire. Data on 60-day postoperative complications will be collected (T1). In the retrospective cohort, available data will be collected from a database of patients who underwent surgery for primary CRC between 2019 and 2024. <bold>Results:</bold> We hypothesize that preoperative malnutrition risk is associated with an increased occurrence of AF. <bold>Conclusion</bold> : The FourColon-Factors study may improve the evidence regarding the prognostic role of nutritional risk on postoperative complications among patients with CRC. Furthermore, it may contribute to the identification of nutrition-related prognostic markers that could enhance clinical risk stratification and support tailored nutritional strategies. </p>