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Risk factors for prolonged postoperative ileus after laparoscopic sphincter-saving total mesorectal excision for rectal cancer: an analysis of 428 consecutive patients

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Abstract

Background

Prolonged postoperative ileus (PPOI) is a common complication after colorectal resection but data regarding PPOI risk factors after laparoscopic rectal cancer surgery is lacking. This study aimed to identify risk factors for PPOI after laparoscopic sphincter-saving total mesorectal excision (TME) for cancer.

Methods

All patients who underwent a laparoscopic sphincter-saving TME for cancer from 2005 to 2014 were identified from our prospective database. PPOI was defined as abdominal distension, nausea, and/or vomiting, requiring a nasogastric tube insertion, during the postoperative period.

Results

Among 428 consecutive patients, 65 patients (15%) presented with POI. In multivariate analysis, male gender (Odds Ratio (OR) 2.3 [1.1–4.5]; p = 0.026, age >70 years (OR: 2.0 [1.1–4.0]; p = 0.037)], conversion to open approach (OR 4.9 [1.5–15.4]; p = 0.007), and intra-abdominal surgical site infection (OR 3.8 [1.9–7.5]; p < 0.001) were identified as independent risk factor for PPOI. PPOI risk was 5% in patients without any risk factor but raised to 11, 28, and 54% in patients with 1, 2, or ≥3 risk factors, respectively (p < 0.001).

Conclusion

PPOI is observed in 15% of the patients after laparoscopic sphincter-saving surgery for rectal cancer. We identified four independent factors for PPOI in multivariate analysis: male, gender, age >70, conversion to open approach, and intra-abdominal surgical site infection, leading to the construction of a simple and pragmatic predictive score. This score might help the surgeon to assess patient at risk of PPOI.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Beaujon Hospital, Pôle des Maladies de l’Appareil Digestif – Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Elisabeth Hain, Léon Maggiori, Cécile Mongin, Justine Prost a la Denise & Yves Panis

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  1. Elisabeth Hain
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  2. Léon Maggiori
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  3. Cécile Mongin
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  4. Justine Prost a la Denise
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  5. Yves Panis
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Correspondence to Yves Panis.

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Elisabeth Hain, Léon Maggiori, Cécile Mongin, Justine Prost a la Denise, and Yves Panis have no conflicts of interest or financial ties to disclose.

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Hain, E., Maggiori, L., Mongin, C. et al. Risk factors for prolonged postoperative ileus after laparoscopic sphincter-saving total mesorectal excision for rectal cancer: an analysis of 428 consecutive patients. Surg Endosc 32, 337–344 (2018). https://doi.org/10.1007/s00464-017-5681-z

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  • DOI: https://doi.org/10.1007/s00464-017-5681-z

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