Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2025; 17(3): 102728
Published online Mar 15, 2025. doi: 10.4251/wjgo.v17.i3.102728
New scoring system for the evaluation obstructive degrees based on computed tomography for obstructive colorectal cancer
Xin-Chang Shang-Guan, Jun-Rong Zhang, Chao-Nan Lin, Shuai Chen, Yong Wei, Wen-Xuan Chen, Lin Pan, Li-Qin Huang, Shao-Hua Zheng, Xian-Qiang Chen
Xin-Chang Shang-Guan, Jun-Rong Zhang, Shuai Chen, Yong Wei, Wen-Xuan Chen, Xian-Qiang Chen, Department of Emergency Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Chao-Nan Lin, Lin Pan, Li-Qin Huang, Shao-Hua Zheng, College of Physics and Information Engineering, Fuzhou University, Fuzhou 350001, Fujian Province, China
Co-first authors: Xin-Chang Shang-Guan and Jun-Rong Zhang.
Co-corresponding authors: Shao-Hua Zheng and Xian-Qiang Chen.
Author contributions: Chen XQ had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis; Shang-Guan XC, Zhang JR, contributed equally to this work and should be considered as co-first authors; Shang-Guan XC, Zhang JR, Zheng SH and Chen XQ contributed to concept and design; Lin CN, Chen S, Chen WX, Pan L and Huang LQ contributed to acquisition, analysis, and interpretation of data; Shang-Guan XC, Zhang JR, Chen S and Lin CN contributed to drafting of the manuscript; Zhang JR, Wei Y and Zheng SH contributed to critical revision of the manuscript for important intellectual content; Shang-Guan XC, Lin CN and Chen S contributed to statistical analysis; Shang-Guan XC, Zhang JR and Chen XQ contributed to funding; Pan L, Zheng SH and Huang LQ contributed to administrative, technical, and material support; Zhang JR, Huang LQ and Chen XQ contributed to supervision.
Supported by the Youth Foundation of Fujian Provincial Health Commission, No. 2021QNA014; and the Construction Project of Fujian Province Minimally Invasive Medical Center, No. [2021]76.
Institutional review board statement: This study was approved by the ethics committee of Fujian Medical University Union Hospital (Approval No. 2022KY102).
Informed consent statement: All patients signed the surgical consent form before surgery and gave informed consent to the pathological examination of postoperative specimens. In addition, this study was a retrospective study, using only the patient's medical records, and there was no intervention in the treatment of the patient, let alone the risk of increasing the patient. This study was committed to protecting patient privacy.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The datasets used in the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xian-Qiang Chen, MD, Department of Emergency Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. cxq760818@163.com
Received: October 28, 2024
Revised: December 27, 2024
Accepted: January 13, 2025
Published online: March 15, 2025
Processing time: 110 Days and 9.2 Hours
Abstract
BACKGROUND

The degree of obstruction plays an important role in decision-making for obstructive colorectal cancer (OCRC). The existing assessment still relies on the colorectal obstruction scoring system (CROSS) which is based on a comprehensive analysis of patients’ complaints and eating conditions. The data collection relies on subjective descriptions and lacks objective parameters. Therefore, a scoring system for the evaluation of computed tomography-based obstructive degree (CTOD) is urgently required for OCRC.

AIM

To explore the relationship between CTOD and CROSS and to determine whether CTOD could affect the short-term and long-term prognosis.

METHODS

Of 173 patients were enrolled. CTOD was obtained using k-means, the ratio of proximal to distal obstruction, and the proportion of nonparenchymal areas at the site of obstruction. CTOD was integrated with the CROSS to analyze the effect of emergency intervention on complications. Short-term and long-term outcomes were compared between the groups.

RESULTS

CTOD severe obstruction (CTOD grade 3) was an independent risk factor [odds ratio (OR) = 3.390, 95% confidence interval (CI): 1.340-8.570, P = 0.010] via multivariate analysis of short-term outcomes, while CROSS grade was not. In the CTOD-CROSS grade system, for the non-severe obstructive (CTOD 1-2 to CROSS 1-4) group, the complication rate of emergency interventions was significantly higher than that of non-emergency interventions (71.4% vs 41.8%, P = 0.040). The postoperative pneumonia rate was higher in the emergency intervention group than in the non-severe obstructive group (35.7% vs 8.9%, P = 0.020). However, CTOD grade was not an independent risk factor of overall survival and progression-free survival.

CONCLUSION

CTOD was useful in preoperative decision-making to avoid unnecessary emergency interventions and complications.

Keywords: Obstructive colorectal cancer; Scoring system; Computed tomography-based obstructive degree; Colorectal obstruction scoring system; Emergency intervention

Core Tip: This retrospective, single-center, observational study explores the relationship between computed tomography-based obstructive degree (CTOD) and the colorectal obstruction scoring system (CROSS) score and evaluates whether the CTOD could affect short-term and long-term prognoses. In this study of 173 patients, CTOD severe obstruction was an independent risk factor. Complications in the form of emergency interventions were more common in patients with CTOD-CROSS non-severe obstruction. The proposed CTOD may be useful in preoperative treatment decision-making and help prevent unnecessary emergency interventions and complications in certain patients.