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

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.