Abstract
BackgroundBowel obstruction (BO) is a complication that commonly affects patients with colorectal cancer (CRC). BO causes severe outcomes, and its treatment leads to a dilemma for many surgeons. Moreover, the factors correlated to BO in preoperative CRC patients remain unclear. The objectives of this study were to investigate the clinical characteristics of BO to identify risk predictors and to construct a BO prediction model with preoperative CRC patients.MethodsA large-scale, retrospective cohort, population-based study analyzed the data of 11,814 patients obtained from the Surveillance, Epidemiology, and End Results and Medicare claims-linked databases (SEER-M database). Patients aged ≥ 66 years and primarily diagnosed with CRC from 1992 to 2009 were divided into BO and non-BO groups. Cox proportional hazards regression models were used to determine predictors, and then, a nomogram was constructed by those predictors.ResultsA total of 11,814 patients (5293 men and 6251 women) were identified. In multivariate analysis, 14 factors were found to be associated with BO including age, race, marital status, residence location, T category, M category, primary tumor site, histologic type, histologic grade, tumor size, history of alcoholism, chemotherapy, radiotherapy, abdominal pain, and anemia. A nomogram predicting the 90- and 180-day rates of BO was built for the preoperative CRC patients with a C-index of 0.795.ConclusionsThis study identified 14 BO-related factors, and a statistical model was constructed to predict the onset of BO in preoperative CRC patients. The obtained data may guide decision-making for the intervention of patients at risk for BO.
Highlights
Bowel obstruction (BO) is a complication that commonly affects patients with colorectal cancer (CRC)
The objectives of this study were to conduct a population-based study to evaluate factors associated with BO and to build a statistical model to predict the development of BO by using data from the Surveillance, Epidemiology, and End Results and Medicare claimslinked databases (SEER-M database)
Socioeconomic status, including income and education level, was not significantly different between the two groups (p = 0.107 and 0.571, respectively), race and marital status were associated with BO, older patients were more likely to develop BO (p < 0.001; Fig. 1a), men were more likely to present with BO than women (27.6% and 25.2%, respectively p = 0.02), living in a large urban area appeared to affect the likelihood of developing BO
Summary
Bowel obstruction (BO) is a complication that commonly affects patients with colorectal cancer (CRC). It is possible to have a complication that can lead to severe results One such complication is BO symptoms at onset are insidious and subtle and can be ignored in clinical practice. In this way, once patients get BO, they often present with intractable nausea, vomiting, and dehydration [6,7,8], which cause considerable distress to patients and their families [9, 10]. Other studies indicate that BO has a poor prognosis even with interventions [4, 13,14,15] These conflicting results often put both physicians and surgeons in an ethical dilemma. It is critical to predict the onset of BO and identify specific
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