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Abstract: Aim: The objective of this study was to find out the effects of anastomotic leakage (AL) following resection of colon cancer upon perioperative outcome and long-term oncological result. Patients and methods: Using the database of a country-wide quality assurance study “Quality Assurance in Primary Colorectal Carcinoma” we analysed the data from the complete sub-population of 844 patients who had AL after resection of colon cancer. These were compared with corresponding data from 27 427 similar patients without AL. Hospital mortality, AL-associated post-operative morbidity and long-term outcome were investigated. Results: Hospital mortality after AL was 18.6%, compared with 2.6% for patients without AI. AL-related secondary complications occurred in 62.7% cases, while patients without AL had a corresponding rate of 19.9%. Those with AL had a poorer long-term oncological result, with a five-year survival rate of 51.0% (p <0.001) and a five-year tumour-free survival rate of 63.0% (compare 74.6% without AL; p <0.001). Conclusions: Post-operative AL after resection of colon cancer is associated with significant morbidity and hospital mortality rates and with a greater risk of a poor oncological outcome. [Copyright &y& Elsevier]