Liu H, Chen Y, Guo SG, Liu Z, Huang YS, Zhu ZD, Feng YJ, Yang Q, Liu YL. Risk factors for prolonged postoperative ileus in elderly patients undergoing laparoscopic radical resection for colorectal cancer. World J Gastrointest Oncol 2026; 18(6): 120007 [DOI: 10.4251/wjgo.v18.i6.120007]
Corresponding Author of This Article
Yang Chen, Associate Professor, Department of Gastrointestinal Surgery, Chaoyang Central Hospital, Postgraduate Training Base of Jinzhou Medical University, No. 26 Chaoyang Street, Shuangta District, Chaoyang 122000, Liaoning Province, China. chenyangsurgeon@qq.com
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Gastroenterology & Hepatology
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research-article
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Liu H, Chen Y, Guo SG, Liu Z, Huang YS, Zhu ZD, Feng YJ, Yang Q, Liu YL. Risk factors for prolonged postoperative ileus in elderly patients undergoing laparoscopic radical resection for colorectal cancer. World J Gastrointest Oncol 2026; 18(6): 120007 [DOI: 10.4251/wjgo.v18.i6.120007]
World J Gastrointest Oncol. Jun 15, 2026; 18(6): 120007 Published online Jun 15, 2026. doi: 10.4251/wjgo.v18.i6.120007
Risk factors for prolonged postoperative ileus in elderly patients undergoing laparoscopic radical resection for colorectal cancer
Huan Liu, Yang Chen, Shi-Gang Guo, Zhu Liu, Yong-Shuai Huang, Zhen-Dong Zhu, Yu-Jie Feng, Qing Yang, Ya-Lei Liu
Huan Liu, Yang Chen, Zhu Liu, Yong-Shuai Huang, Zhen-Dong Zhu, Yu-Jie Feng, Department of Gastrointestinal Surgery, Chaoyang Central Hospital, Postgraduate Training Base of Jinzhou Medical University, Chaoyang 122000, Liaoning Province, China
Yang Chen, Shi-Gang Guo, Model Worker Innovation Studio, Chaoyang Central Hospital, Chaoyang 122000, Liaoning Province, China
Shi-Gang Guo, Qing Yang, Ya-Lei Liu, Department of Gastrointestinal Surgery, Chaoyang Central Hospital, China Medical University, Chaoyang 122000, Liaoning Province, China
Co-first authors: Huan Liu and Yang Chen.
Author contributions: Chen Y and Guo SG contributed to the study conception and design; Liu H, Zhu ZD, Feng YJ, Yang Q and Liu YL collected and assembled the data; Liu Z and Huang YS performed data quality control; Liu H analyzed the data and drafted the manuscript; Chen Y supervised and revised the paper; and all the authors read and approved the final manuscript. Liu H and Chen Y contributed equally to this work as co-first authors.
Supported by Science and Technology Project for Youth of Chaoyang Central Hospital, China Medical University, Liaoning Province.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Chaoyang Central Hospital, China Medical University (Approval No. 2025-30) and registered with the Chinese Clinical Trial Registry (ChiCTR2500106754). All the data were fully anonymized before statistical analysis.
Informed consent statement: The requirement for informed consent was waived by the Ethics Committee due to the retrospective nature to the study.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets generated and/or analysed during the current study are anonymized before analysis and not publicly available due to patients’ privacy protection but are available from the corresponding author on reasonable request.
Corresponding author: Yang Chen, Associate Professor, Department of Gastrointestinal Surgery, Chaoyang Central Hospital, Postgraduate Training Base of Jinzhou Medical University, No. 26 Chaoyang Street, Shuangta District, Chaoyang 122000, Liaoning Province, China. chenyangsurgeon@qq.com
Received: February 13, 2026 Revised: March 8, 2026 Accepted: March 20, 2026 Published online: June 15, 2026 Processing time: 117 Days and 1.7 Hours
Abstract
BACKGROUND
As the elderly population of patients with colorectal cancer (CRC) has increased, the risk of postoperative complications, particularly prolonged postoperative ileus (PPOI), has similarly increased in frail patients; this finding has hindered the postoperative recovery process. However, the risk factors for PPOI in elderly patients following laparoscopic radical resection for CRC remain unclear.
AIM
To investigate and analyze the incidence and potential risk factors for PPOI in elderly patients with CRC following laparoscopic radical resection.
METHODS
A single-center, retrospective study was conducted involving 167 patients who underwent laparoscopic radical CRC resection from November 2018 to June 2025. Clinical data on baseline characteristics, preoperative laboratory tests, intraoperative and postoperative parameters, and pathological outcomes were collected and analyzed. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for PPOI, and a P value of < 0.05 was considered to indicate statistical significance. Receiver operating characteristic curves were plotted, bootstrap validation was performed, and calibration curves and decision curve analysis were constructed.
RESULTS
In this study, 49 patients developed PPOI (29.30%), whereas 71 patients experienced frailty (42.50%). The multivariate analysis revealed that modified 5-item Frailty Index (mFI-5) ≥ 2 (P = 0.028), postoperative opioid use (P = 0.021), and serum potassium levels on postoperative day 1 (POD 1) < 3.61 mmol/L (P = 0.003) were associated with PPOI. The area under the curve (AUC) analysis demonstrated a predictive performance of 0.730 [95% confidence interval (CI): 0.649-0.811] for PPOI in elderly patients, with a bootstrap-validated AUC of 0.730 (95%CI: 0.644-0.800).
CONCLUSION
PPOI is a common postoperative complication in elderly patients with CRC following laparoscopic radical resection, while an mFI-5 ≥ 2, postoperative opioid use, and low serum potassium levels on POD 1 are independent risk factors. The predictive model constructed on the basis of these indicators demonstrated moderate discrimination. The optimization of perioperative evaluation and management protocols is crucial for reducing the incidence of PPOI.
Core Tip: This single-center retrospective study investigated and analyzed the incidence and risk factors for prolonged postoperative ileus (PPOI) in geriatric patients with colorectal cancer following laparoscopic radical resection. A more comprehensive and accurate risk stratification model for PPOI was developed by jointly assessing the patients' global functional status and modifiable clinical indicators, which provided empirical evidence to support the development of individualized and precise perioperative management in the future. For elderly patients, optimizing perioperative evaluation and management protocols is crucial to reduce the incidence of PPOI and promote postoperative recovery.
