The impact of postoperative recurrent postoperative ileus on the prognosis of colorectal cancer: a propensity score matched study.

Abstract

To assess the correlation between recurrent postoperative ileus (RPOI) and clinical prognosis in patients with colorectal cancer after radical surgery. A retrospective analysis of 682 stage I-III colorectal cancer patients undergoing surgery at Longyan First Hospital, Fujian Medical University (January 2016-December 2018), identified 50 patients (7.3%) with RPOI and 632 (92.7%) without. The primary endpoints were 3-year recurrence-free survival (RFS) and 3-year overall survival (OS). RFS and OS were compared using the Kaplan-Meier method. A Cox regression model was leveraged to appraise independent prognostic factors. The 3-year RFS rate in the RPOI group was 70.3%, significantly lower than that in the non-RPOI group (82.2%, P = 0.032); the 3-year OS rate in the RPOI group was 71.2%, also significantly lower than that in the non-RPOI group (90.7%, P = 0.004). After propensity score matching (PSM), the results remained unchanged. Univariate regression analysis indicated that lymphovascular invasion, nerve invasion, pT stage, pN stage, pTNM stage, preoperative serum carcinoembryonic antigen levels, RPOI, and serum albumin levels on the first postoperative day (POD 1) were associated with RFS in colorectal cancer patients (all P < 0.05). Multivariate analysis confirmed RPOI (HR = 2.240, 95% CI: 1.104-4.544, P = 0.025) as an independent negative prognostic factor for RFS. Patients who develop RPOI after radical colorectal cancer surgery experience longer intervals before their first postoperative chemotherapy, longer hospital stays, and poorer RFS and OS.