Risk factors for small bowel obstruction after open rectal cancer resection

Abstract

Background Small bowel obstruction (SBO) is observed in around 10% of patients with prior open abdominal surgery. Rectal resection causes the highest readmission rates. The aim of this study was to investigate risk factors for readmission for SBO and causes for SBO in patients who needed surgery following rectal cancer surgery. Methods A population-based registry with prospectively gathered data on 752 consecutive patients with rectal cancer who underwent open pelvic surgery between January 1996 and January 2017 was used. Univariable and multivariable regression analysis was performed, and the risk of SBO was assessed. Results In total, 84 patients (11%) developed SBO after a median follow-up time of 48 months. Of these patients, 57% developed SBO during the 1st year after rectal cancer surgery. Surgery for SBO was performed in 32 patients (4.3%), and the cause of SBO was stoma-related in one-fourth of these patients. In the univariable analysis previous RT and re-laparotomy were found as risk factors for readmission for SBO. Re-laparotomy was an independent risk factor for readmission for SBO (OR 2.824, CI 1.129–7.065, P = 0.026) in the multivariable analysis, but not for surgery for SBO. Rectal resection without anastomoses, splenic flexors mobilization, intraoperative bleeding, operative time were not found as risk factors for SBO. Conclusions One-tenth of rectal cancer patients who had open surgery developed SBO, most commonly within the 1st postoperative year. The risk of SBO is greatest in patients with complications after rectal cancer resection that result in a re-laparotomy.

Incidence of adhesive small bowel obstruction after surgery for colorectal cancer in Sweden 2007–2016

“…Nevertheless, our estimates of relative SBO incidence after both colon and rectal cancer surgery were similar to those reported by others [4,12]; also SBO surgery was as common as in other studies [12,41]. After rectal cancer surgery, slightly fewer patients experienced SBO and SBO surgery than reported in many studies [6,18,42].…”

“…In line with previous studies, SBO surgery was twice as common after open surgery compared with after MIS. Conservatively managed SBO in rectal cancer patients is reported to occur in 5%-18% of non-irradiated patients [16,45] compared with 12%-29% after radiotherapy [16,18]. In this aspect, our study displayed a cumulative incidence similar to that reported in other studies [15][16][17][18]; however, a small study with 15-year follow-up found a much higher cumulative incidence (29%) [45].…”

“…Previous studies concerning SBO and SBO surgery after colorectal procedures are heterogeneous in design and follow‐up time (Appendix A) [4, 6, 11, 12, 18, 41–43]. Hence, direct comparisons are difficult.…”

“…Conservatively managed SBO in rectal cancer patients is reported to occur in 5%-18% of non-irradiated patients [16,45] compared with 12%-29% after radiotherapy [16,18]. In this aspect, our study displayed a cumulative incidence similar to that reported in other studies [15][16][17][18]; however, a small study with 15-year follow-up found a much higher cumulative incidence (29%) [45]. Studies on SBO surgery after radiotherapy are scarce, but our study showed a similar incidence to what others have reported [17,18] but a higher HR than in the study by Egenvall et al [27].…”

“…Overall complications [20], and specifically anastomotic leakage [11], fascial dehiscence [6,21] and reoperations [18], have been described as risk factors for SBO and so has bleeding [7,11,16,22] and the presence of a stoma [6,[23][24][25]. Moreover, other factors such as age, sex, smoking and body mass index (BMI) may also be related to the risk of future SBO [6,7,11,26].…”