- A retrospective study

- Colorectal cancer patients who underwent robotic surgery

- Between March 2020 and March 2025

- All cases followed an enhanced recovery after surgery (ERAS) protocol

- Patients were stratified based on the development of POI. POI: Absence of bowel function recovery after postoperative day 4

- Operative time, location of the operation, presence of fibrosis from prior radiotherapy, adhesions from prior surgery, length of hospital stay, postoperative return of bowel movements, estimated blood loss (EBL), presence of postoperative complications within 30 days, and 30-day readmissions related to surgery were reviewed

- Statistical analyses were performed using the Mann-Whitney U test, Fisher’s exact test, and multivariate logistic regression analysis

 

Results

POI patients were

        - Significantly older (mean 64.5 vs. 58.3 years; p = 0.014),

        - Had higher intraoperative blood loss (median 75 mL vs. 50 mL; p = 0.025) 

        - Had longer operative times (median 6.75 hours vs. 5.0 hours; p = 0.001)

 

The incidence of POI was significantly higher in patients with fibrosis (26.7% vs. 12.7%; OR = 2.93, 95% CI: 1–8.1; p = 0.036) and adhesions (46.7% vs. 9.3%; OR = 5.37, 95% CI: 2.14–13.53; p < 0.001) (Table 1)

 

        - Longer operative time (OR = 1.39, 95% CI: 1.09–1.82; p = 0.011)

        - Adhesions from prior surgery (OR = 6.25, 95% CI: 2.27–18.21; p = 0.0005) were independently associated with higher odds of developing POI (Table 2)

 

Conclusion

Colorectal cancer patients with adhesions from prior surgery have a higher incidence of POI. This information is important for postoperative planning and expectations, as well as providing an opportunity for potential targeted prophylactic interventions for ileus within ERAS protocols.

 

Table 1: Univariate Analysis of Factors Associated with Postoperative Ileus

Table 2 : Multivariate Logistic Regression Analysis for Predictors of Postoperative Ileus