Postoperative Mechanical Ileus Requiring Surgery in Patients with Colorectal Cancer

ABSTRACT

BACKGROUND: Postoperative ileus is not an infrequent problem in clinical practice and is the major cause of morbidity with occasional mortality. The purposes of this study were to analyze clinical features and to assess associated risk factors in postoperative mechanical ileus. METHODS: We reviewed the cases of 43 patients with mechanical ileus who had undergone exploration from among the 1631 colorectal cancer patients treated between June 1989 and December 1997. RESULTS: The causes of postoperative ileus were postoperative adhesion, recurrence of cancer, and hernia, and these causes were closely associated with postoperative periods (period I, 12 months). Adhesion was the most common cause of obstruction in the early postoperative period (period I, 86%), while cancer recurrence increased with time (period I: 7%, period II: 36%, period III: 53%). The clinical features of simple and strangulated obstructions were not significantly different. We could find no significant correlation between clinicopathological findings of the tumor and postoperative ileus requiring surgery. Among 874 rectal cancer patients, 122 patients (15.1%) received adjuvant radiation therapy (RT) postoperatively. The cases receiving RT presented a significant increase in the incidence of postoperative ileus and surgical treatment (28% vs 7.5%, 15% vs 1%, respectively, p<0.001). CONCLUSIONS: major cause of postoperative mechanical ileus requiring surgery in colorectal cancer patients was adhesion until one year postoperatively and cancer recurrence thenafter. Postoperative RT seems to be a risk factor of postoperative mechanical ileus.