Published online May 15, 2026. doi: 10.4251/wjgo.v18.i5.115303
Revised: November 26, 2025
Accepted: February 2, 2026
Published online: May 15, 2026
Processing time: 195 Days and 1 Hours
Postoperative complications in colorectal cancer surgery occur in 20%-50% of patients, significantly impacting recovery and prognosis. Traditional clinical prediction models have limited efficacy for preoperative risk assessment. Spectral computed tomography (CT) provides quantitative parameters including iodine concentration (IC) that may improve complication prediction, though systematic studies remain limited.
To investigate the value of preoperative spectral CT multi-parameters in pre
A retrospective cohort analysis was conducted on clinical data and preoperative spectral CT imaging data of 195 colorectal cancer patients from March 2022 to August 2025. Abdominal dual-phase enhanced scanning was performed using a GE Revolution CT spectral scanner, measuring parameters including tumor IC, normalized IC (NIC), effective atomic number, and spectral attenuation curve slope. Postoperative complications were assessed using the Clavien-Dindo classification system. Univariate and multivariate logistic regression analyses were used to screen independent predictive factors, establish a predictive model, and evaluate its performance.
Among 195 patients, 16 developed postoperative complications with an incidence rate of 8.2%. Patients in the complication group had significantly lower arterial phase and portal venous phase (PV) tumor IC, NIC, effective atomic number, and spectral attenuation curve slope compared to the non-complication group (P < 0.001). Multivariate analysis identified 5 independent predictive factors: Age [odds ratio (OR) = 1.042, P = 0.023], albumin (OR = 0.881, P = 0.007), PV tumor NIC (OR < 0.001, P < 0.001), tumor-nodes-metastasis stage (OR = 3.274, P = 0.030), and intraoperative blood loss (OR = 1.003, P = 0.009). The combined predictive model had an area under the curve of 0.843 (95% confidence interval: 0.789-0.897), with sensitivity of 75.3% and specificity of 80.3%. Bootstrap internal validation showed a bias-corrected C-index of 0.821, demonstrating good stability.
Preoperative spectral CT multi-parameters have important value in predicting postoperative complications in colorectal cancer. PV tumor NIC is the most valuable imaging predictive factor. The predictive model established by combining clinical indicators has good predictive efficacy and can be used for preoperative risk stratification and individualized treatment strategy formulation.
Core Tip: This study developed a preoperative model combining spectral computed tomography parameters and clinical factors to predict postoperative complications in colorectal cancer. The portal venous phase normalized iodine concentration was identified as the most valuable imaging biomarker. The integrated model showed good discrimination (area under the curve = 0.843) and calibration (C-index = 0.821), providing a noninvasive tool for preoperative risk stratification and individualized perioperative management in colorectal cancer patients.