Preoperative Controlling Nutritional Status (CONUT) Score Might Be a Predictive Biomarker of Postoperative Mortality within 90 Days after Surgery in Patients with Malignant Bowel Obstruction Caused by Unresectable Colorectal Cancer.

OBJECTIVES

This study aims to evaluate the short-term surgical outcomes and clarify the risk factors of mortality and morbidity within the 90 days following palliative surgery for malignant bowel obstruction (MBO) caused by unresectable colorectal cancer (CRC) from an immuno-nutritional point of view.

METHODS

66 patients had palliative surgery for MBO caused by unresectable CRC due to metastatic and recurrent tumors between January 2005 and December 2021. We evaluated 57 patients, excluding nine due to missing data. In a multivariate analysis, clinically relevant variables, including age, American Society of Anesthesiologists Physical Status Classification, Controlling Nutritional Status (CONUT) score, Prognostic Nutrition Index (PNI), and perioperative factors, were evaluated as potential risk factors.

RESULTS

Three (5.3%) patients died within 30 days. Clavien-Dindo classification grade (C-D) ≥3 complications occurred in 10 (17.5%) patients. Although all patients required stoma creation, they resumed oral intake in 3 postoperative days (range, 1-9). The median overall survival was 224 days, with a 90-day mortality rate of 24.6%. In the multivariable analyses, a higher preoperative CONUT score was significantly associated with 90-day mortality. In addition, both a higher CONUT score and emergency surgery were significantly associated with the occurrence of C-D grade ≥3 complications.

CONCLUSIONS

A higher preoperative CONUT score may provide valuable prognostic information regarding short-term outcomes, including 90-day mortality and severe postoperative complications, following palliative surgery for MBO caused by unresectable colorectal cancer.