EP676 - Risk Factors for Obstructive Presentation in Colorectal Cancer

Purpose/Background: Colorectal cancer is a major source of morbidity and mortality worldwide. A proportion of patients present emergently with obstructive pathology resulting in poorer outcomes compared to those who present electively. In this study, we evaluate risk factors for obstruction at the time of presentation for patients with colon and rectal cancer at a single institution.

Methods/Interventions: A single institution retrospective review was performed to compare patients who presented with obstructive pathology to those who presented electively. Inclusion criteria included patients who presented with an initial diagnosis of primary colon or rectal adenocarcinoma from 2020-2022. Patients with recurrent disease or incomplete clinical data were excluded. Patients were categorized as obstructed or not obstructed based on endoscopic, radiologic, and clinical data. Demographic, clinical and pathologic variables were collected and included age, sex, race, body mass index (BMI), tobacco use, Rural-Urban Commuting Area (RUCA) score, insurance status, and cancer stage, A comorbidity score was calculated using the Charlson Comorbidity Index. Statistical analyses were performed using Jamovi. Univariate analyses were conducted using χ² or Fisher's exact tests for categorical data and independent t-tests or Mann-Whitney U tests for continuous data. Statistical significance was defined as p < 0.05.

Results/Outcomes: A total of 201 patients met inclusion criteria of which 51 (25.4%) presented with obstruction. The median age of obstructed patients was 58.2 years (IQR 51.1-65.5) and non-obstructed patients was 60.6 years (IQR 50.5-70) (p = 0.185). There were no significant differences in gender, race, smoking status, insurance status, or rurality as assessed by RUCA score. There was also no significant difference in tumor location (colon vs rectal cancer) (p=0.761). Obstructed patients were more likely to present with a lower BMI (26.4 +/- 6.40 vs 30.3 +/- 8.92, p=0.001)), an elevated Charleson Comorbidity Index (6.29 +/- 2.64 vs 5.53 +/- 2.55, 0.037), and advanced tumor stage (p < 0.001)

Conclusion/Discussion: Patients with colorectal cancer who present with obstructive pathology have increased morbidity and mortality. In this single center intuitional retrospective review, 25% of patients with colorectal cancer presented with obstruction. Obstruction was associated with a lower BMI, higher comorbidity score, and more advanced tumor stage.