Propensity score-matched analysis of risk factors for prolonged postoperative ileus after TME in rectal cancer

Prolonged postoperative ileus (PPOI) is a common complication following total mesorectal excision. Early detection and prompt intervention are crucial for the treatment of rectal cancer.

We conducted a retrospective study. After applying propensity score matching, we collected and compared the clinical characteristics of 164 patients in both the PPOI group and the non-PPOI group using univariate analysis. Significant factors identified were then evaluated in a multivariable logistic regression analysis. Moreover, we analyzed the clinical features and treatment strategies.

The incidence of PPOI after laparoscopic TME was 18.3% in our trial. Univariate analysis revealed significant differences in several factors between the two groups, including prophylactic anaerobic antibiotic therapy (p < 0.001), preoperative bowel obstruction (p = 0.006), preoperative nutritional support therapy (p < 0.001), and the type of stoma (p < 0.001). However, further multivariable logistic regression analysis indicated that prophylactic anaerobic antibiotic therapy was not an independent risk factor for PPOI. Among the patients who experienced PPOI, the majority, 135 patients (82.3%), presented with Clavien-Dindo grades I-II. Overall, 81.7% and 85.4% of patients received oral probiotics and vancomycin treatment, respectively. Only 48 patients (29.3%) required gastric tube insertion, while 27 patients (16.5%) needed a transnasal ileus tube due to ineffective drug treatment.

Our study suggests that selecting the appropriate preoperative nutritional support strategy and type of stoma is crucial in reducing the incidence of PPOI. When PPOI occurs, a multi-stage treatment protocol may be beneficial for recovery.