Published online Sep 27, 2026. doi: 10.4240/wjgs.119675
Revised: April 27, 2026
Accepted: June 2, 2026
Published online: September 27, 2026
Processing time: 171 Days and 22.4 Hours
Early identification of patients with colorectal cancer (CRC) at risk of lymph node metastasis (LNM) and delayed recovery of postoperative intestinal function may improve perioperative optimization, postoperative surveillance, and individualized treatment planning. Multivariate logistic regression is suitable for inte
To identify risk factors and construct multivariate logistic regression models predicting delayed postoperative intestinal function recovery and LNM in CRC.
This retrospective observational study included 197 patients with CRC who underwent radical resection. To analyze intestinal function recovery, 49 patients and 148 patients were assigned to the delayed and normal groups, respectively, based on delayed gastrointestinal function recovery. To analyze nodal status, 68 patients and 129 patients were assigned to the LNM-positive and LNM-negative groups, respectively, based on postoperative pathological findings. Univariate and multivariate analyses identified independent predictors, and area under the curve and decision curve analyses evaluated model performance.
The delayed group had significantly higher rates of preoperative hypoalbuminemia (30.6% vs 10.1%), blood loss > 50 mL (46.9% vs 18.2%), and T3-4 tumors (85.7% vs 58.1%) than the normal group. The delayed group also exhibited persistently higher postoperative C-reactive protein and lower albumin levels (all P < 0.05). The LNM-positive group had more poorly differentiated tumors (45.6% vs 17.1%), fewer harvested lymph nodes (< 12; 27.9% vs 10.1%), and higher fibrinogen levels than the LNM-negative group. Multivariate analysis confirmed that low albumin levels [odds ratio (OR) = 3.86], blood loss > 50 mL (OR = 2.77), and T3-4 stage (OR = 3.49) were independent risk factors for delayed gastrointestinal function recovery. Poor differentiation (OR = 4.39), < 12 lymph nodes harvested (OR = 4.10), and high fibrinogen (≥ 4 g/L, OR = 2.48) were independent risks for LNM.
The constructed multivariate logistic regression models may serve as useful adjuncts for perioperative risk stratification and individualized management, although their clinical generalizability requires validation in larger prospective multicenter studies.
Core Tip: Lymph node metastasis and delayed recovery of postoperative intestinal function are critical factors influencing short-term recovery and long-term prognosis in patients with colorectal cancer. Using outcome-based grouping, we constructed and validated multivariate logistic regression models that integrated readily available perioperative clinical, pathological, and laboratory variables. The models identified key independent risk factors including preoperative hypoalbuminemia, intraoperative blood loss, tumor stage, tumor differentiation, lymph node yield, and fibrinogen levels. With good discrimination and clinical benefit demonstrated by receiver operating characteristic and decision curve analyses, these models provide early risk stratification, individualized perioperative management, and optimized clinical decision-making in colorectal cancer surgery.