Prevalence and risk factors for postoperative ileus in colorectal cancer patients: a systematic review and meta-analysis

TL;DR

This study finds that about 9% of colorectal cancer patients experience postoperative ileus, with factors like open surgery and longer operations increasing the risk.

Contribution

A systematic review and meta-analysis identifying specific risk factors for postoperative ileus in colorectal cancer patients.

Findings

The overall prevalence of postoperative ileus in colorectal cancer patients is 9%.

Male gender, open surgery, and longer operative times are significant risk factors for postoperative ileus.

Abstract

Postoperative ileus (POI) is a common complication following colorectal cancer surgery, with its incidence and risk factors remaining controversial. This study aims to investigate the overall prevalence of POI in colorectal cancer patients and its risk factors through a meta-analysis.

A systematic search was conducted in the Web of Science, Cochrane Library, PubMed, and Embase databases from their inception to August 7, 2025. Two researchers independently screened studies, extracted data, and assessed the risk of bias in the included studies. Statistical analysis was performed using Stata 15.1.

Thirty studies involving 73,433 patients were included, with 7,463 cases of POI. The overall Prevalence of POI in colorectal cancer patients was [ES = 9%, 95% CI: 8%–11%]. Meta-analysis showed that male [OR = 2.20, 95% CI: 1.76–2.76], operative time >3 hours [OR = 1.75, 95% CI: 1.20–2.40], open surgery [OR = 2.95, 95% CI: 2.20–3.95], ileostomy [OR = 4.78, 95% CI: 2.30–9.94], previous abdominal surgery [OR = 2.21, 95% CI: 1.75–2.79], and age≥65 years [OR = 1.04, 95% CI: 1.01–1.06] may be potential risk factors for POI in colorectal cancer patients. The included studies were of high quality, and no significant publication bias was detected.

Based on existing evidence, male, operative time >3 hours, open surgery, ileostomy, previous abdominal surgery, and age≥65 years may be potential risk factors for POI in colorectal cancer patients.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251121761.

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