Risk factors for early postoperative small bowel obstruction after colectomy for colorectal cancer.
BACKGROUND
Small bowel obstruction (SBO) after colectomy leads to markedly lower patient quality of life, longer hospital stays, and increased hospitalization costs. From a systemic treatment point of view, early postoperative SBO is one of the major concerns of the surgery because it often delays chemotherapy in advanced cases. The goal of this single-center study was to evaluate the risk factors for early postoperative SBO.


METHODS
Univariate and multivariate analyses were performed for 1,004 patients who underwent open colectomy (OC, 421 patients) or laparoscopic-assisted colectomy (LAC, 583 patients) for colorectal cancer between January 1997 and December 2008.


RESULTS
The overall early postoperative SBO were 45 cases (4.5%). Univariate analysis of the risk factors for early postoperative SBO showed no statistical significance between respective risk factors and occurrence of SBO for age >70 years, body mass index >25 kg/m(2), ASA score > or =3, pT stage T4, pN stage > or =N1, pM stage M1, or increased blood loss. Multivariate analysis demonstrated that OC (odds ratio (OR), 2.62; 95% confidence interval (CI), 1.34-5.13; P = 0.005), and rectal cancer (OR, 2.12; 95% CI, 1.1-4.1; P = 0.025) were independent risk factors for postoperative SBO after colectomy for colorectal cancer. Regarding the causes of SBO, paralytic obstruction was more frequent in the LAC group, and adhesive obstruction was more frequent in the OC group.


CONCLUSIONS
Early postoperative SBO cases are more likely to occur with OC and rectal cancer. LAC is an effective surgical procedure from the perspective of reducing the incidence of early postoperative SBO after colectomy for colorectal cancer.
Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Japan. junnaka@iwate-med.ac.jp
Jun
J
Nakajima
Akira
A
Sasaki
Koki
K
Otsuka
Toru
T
Obuchi
Satoshi
S
Nishizuka
Go
G
Wakabayashi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007421:Intestine, Small; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult