Risk factors for early postoperative small-bowel obstruction after colectomy in colorectal cancer

Currently, colectomies are the most frequently performed procedure to manage colorectal cancer. However, early postoperative small-bowel obstruction (EPSBO) is a common serious complication after colectomy. The purpose of our study was to assess the incidence of EPSBO after colectomy for colorectal cancer, and attempt to identify associated risk factors for EPSBO.

Between 2005 and 2006, 504 patients who underwent a colectomy for colorectal cancer were prospectively monitored and entered into the study. Patients were assessed to have an EPSBO if, within the first 30 days, they presented with symptoms, such as nausea, vomiting, and abdominal distention, lasting for at least 2 days, with radiologic findings of small-bowel obstruction after evidence of small-bowel motility return. In this study, the following parameters were monitored prospectively: anti-adhesive, intraoperative adverse events (bleeding, bowel perforation), diversion stoma, repair of mesenteric defect, intra-abdominal drainage, local remnant tumor, status of bowel preparation, status of American Society of Anesthesiologists (ASA) grade, obesity, and history of previous abdominal surgery. The influence of these factors on the development of EPSBO after colectomies for colorectal cancer was analyzed. Cases were classified according to anastomotic level and extent of pelvic dissection into pelvic surgery group (PSG) and colonic surgery group (CSG). The influence of these factors on the development of EPSBO according to our classification also was analyzed.

EPSBO developed in 41 cases (8.1%) and was the most frequently occurring complication during the early perioperative period. The frequency of EPSBO according to our classification of cases into PSG and CSG shows that EPSBO developed in 6.8% of PSG compared with 10.6% of CSG cases (p = 0.13). Local remnant tumor (odds ratio (OR) = 3.4) and poor ASA grading (OR = 3.5) were independent risk factors for the development of EPSBO after colectomies for colorectal cancer. In our subgroup analysis according to our classification based on anastomotic level and extent of pelvic dissection, local remnant tumor and poor ASA grading also independently increased the risk of developing EPSBO in PSG.

It seems that pelvic surgeries do not have a higher rate of EPSBO compared with colonic surgeries. Local remnant tumor and poor systemic condition seems to be independent risk factors for EPSBO after colectomies for colorectal cancer, especially with pelvic surgery. These findings suggest that particular attention is needed to reduce the rate of EPSBO in patients who undergo colectomies for colorectal cancer.