Impact of Chronic Obstructive Pulmonary Disease on surgical outcomes of Patients with Colorectal cancer

Impact of Chronic Obstructive Pulmonary Disease on surgical outcomes of Patients with Colorectal cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Chronic Obstructive Pulmonary Disease on surgical outcomes of Patients with Colorectal cancer Jian-Qi Wang, Xin-er Zhang, Gao-ming Chen, Yi-xiang Wu, Xiao Yang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4590558/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The impact of chronic obstructive pulmonary disease (COPD) on perioperative complications and prognosis in patients with colorectal cancer (CRC) is explored. Methods: Fifty-eight CRC patients with COPD and 671 CRC patients without COPD who underwent surgery for CRC in our hospital were retrospectively analyzed. Sociodemographic and clinical variables including tumor status, operative and anesthesia duration, length of hospital stay, the time of postoperative catheter removal and first defecation were compared between the two cohorts. Furthermore, postoperative intensive care unit (ICU) admission, use of mechanical ventilation, fiberoptic bronchoscopy rates, postoperative antibiotic treatment, presence of complications and cancer-specific survival (CSS) or disease-free survival (DFS) were analyzed. Finally, COX regression analysis was used to identify independent risk factors for overall survival (OS) in CRC patients. Results: COPD and Tumor-Node-Metastasis (TNM) stages were independent risk factors for the postoperative OS in patients undergoing surgery for CRC. Moreover, time of postoperative urinary catheter removal and first defecation, ICU admission, use of mechanical ventilation, and fiberoptic bronchoscopy rates were significantly higher in CRC patients with COPD than in those without COPD. Furthermore, postoperative pneumonia and septic shock were more common in patients with COPD. However, COPD was not associated with CSS or DFS in CRC patients. Conclusions: COPD is an independent risk factor for OS in CRC patients after surgery, and is correlated with more postoperative complications, but it is not associated with CSS or DFS. Thus, surgical resection is recommended for selective CRC patients with COPD under the condition of more intensive postoperative care. Colorectal cancer (CRC) Chronic obstructive pulmonary disease (COPD) Surgery Complications Prognosis Figures Figure 1 Figure 2 Figure 3 1. Introduction Colorectal Cancer (CRC) is one of the most common solid malignant tumors and the second largest cause of cancer-related death in the world. In 2020, there were 1.88 million new cases of CRC, accounting for 9.7% of all malignancies, and 916,000 deaths, taking up 9.2% of all malignancies [ 1 ]. According to the latest statistics, more than half of the CRC patients are newly diagnosed at 65 years and above [ 2 ]. Surgical resection is the mainstay of treatment for localized CRC. However, the increase of age and the growing number of comorbidities are contributed to poorer prognosis after surgery in CRC patients [ 3 ]. Therefore, major challenges have been posed to surgeons for elderly CRC patients with comorbidities during the perioperative period. Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases in the world, with a high disability and mortality rate, which brings about long-term life troubles and economic burdens to patients [ 4 ]. COPD is a systemic disease that, in addition to irreversible airflow limitation changes in the lungs, can adversely affect vital organs other than the lungs, such as the intestines [ 4 , 5 ]. Previous studies have shown that COPD patients are more likely to experience gastrointestinal (GI) symptoms, have a higher prevalence of GI disorders, and are more likely to receive treatment for intestinal disorders [ 6 – 8 ]. Previous study has shown that the incidence of colorectal adenomatous polyps is significantly higher in COPD patients than healthy people [ 9 ]. COPD is a risk factor for colorectal adenomatous polyps and the development of CRC[ 9 , 10 ]. The underlying mechanisms might be related to changes in intestinal permeability and loss of barrier function caused by tissue hypoxia, chronic inflammatory reaction and autonomic nervous dysfunction [ 11 – 14 ]. Most CRC patients are diagnosed at a relatively advanced age when chronic comorbidities including COPD often co-exist [ 3 , 15 ]. For elderly CRC patients with COPD, surgery may be the best treatment modality. However, these patients often have various lung function limitations, which can lead to decreased tolerance to surgery and increased incidence of postoperative complications [ 16 ]. It has been reported that CRC patients with COPD had poorer survival than those without COPD after CRC resection [ 15 , 17 – 19 ]. In addition, relevant studies from different regions have indicated that the prevalence of postoperative pneumonia in patients with COPD is higher than that in those without COPD [ 17 , 20 , 21 ]. However, the reports on perioperative prognosis and overall survival of patients with or without COPD are inconsistent. Surgery for patients with COPD often brings vast challenges to surgeons because they need to comprehensively assess the benefits and relevant risks of surgery before developing clinical proposals. Nevertheless, effective reference basis for the clinical proposals is very limited. This study retrospectively analyzed the clinical data of patients undergoing CRC surgery in our center, and further explored the influence of COPD on the CRC patients during the perioperative period to provide more clinical references for surgical treatment of CRC patients with COPD. 2. Material and Methods 2.1 Patients In this study, clinical data were retrospectively collected from the patients who underwent colorectal resection for primary CRC from January 2014 to December 2022 in our hospital. All patients were followed-up by a review of the electronic outpatient and inpatient records and telephone. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), patients with a FEV1/FVC ratio of less than 0.70 following bronchodilator inhalation on lung function tests are diagnosed as having COPD [ 4 ]. Thus, the patients included in the study were divided into two cohorts: COPD cohort (those with COPD) and non-COPD cohort ( those without COPD). 2.2 Inclusion and Exclusion Criteria Inclusion criteria for this study were: 1) Patients received CRC resection; 2) Postoperative pathological findings confirmed primary CRC, including tubular adenocarcinoma, mucinous adenocarcinoma, signet-ring cell carcinoma, and intramucosal carcinoma; 3) Age over 18 years old; 4) Complete clinical information (including patient general information, preoperative related blood test, surgery related data, postoperative pathological information, etc.). 5) All enrolled patients had signed informed consent, and the agreement was reviewed and approved by the Ethics Committee. Exclusion Criteria for this study were: 1) Patients with multiple primary CRC or other severe comorbidity; 2) Patients with concomitant or previous other primary malignancies. 2.3 Variables and Data Collection Data on the following clinical variables were collected in detail from electronic clinical records or telephone interviews with patients and families using structured questionnaires and manuals by appropriately trained investigators: General information of the patient: age, sex, body mass index (BMI), smoking and alcohol consumption history, diabetes, hypertension, coronary heart disease, admission and discharge date; Preoperative serum GI tumor indicators: Carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), Carbohydrate antigen (CA) 199 and CA724 levels; Information about CRC surgery: American Society of Anesthesiologists (ASA) score (grades I to IV), date of surgery, operation timing, method of surgery, operative duration, anesthetic duration, intraoperative blood loss, and intraoperative blood transfusion; Tumor status: maximum tumor diameter, pathological TNM tumor stage (AJCC 8th Edition), tumor location, differentiated degree, histological type, nerve invasion, and vessel carcinoma embolus; Postoperative treatment related information: ICU stay days, abdominal drainage tube removal time, urinary tube removal time, first defecation time, antibiotic use, postoperative blood transfusion, glucocorticoid use, rescue times and reasons, assisted ventilation, invasive assisted ventilation, hemodialysis, intravenous pressor or vasoconstrictor use; Incidence of complications: pneumonia, wound infection, incision dehiscence, intestinal obstruction, abdominal infection, urinary tract infection, septic shock, hypovolemic shock, respiratory failure, acute heart failure, anastomotic leakage, anastomotic bleeding, acute kidney injury and catheter-related complications, etc; The selection of neoadjuvant chemotherapy regimens was generally similar to postoperative adjuvant chemotherapy regimens (FOLFOX regimen (oxaliplatin + fluorouracil) or CapeOX regimen (oxaliplatin + capecitabine)). If chemotherapy was effective to advanced CRC, further surgery was performed and the original chemotherapy regimen was continued after surgery. Patients with poor physical conditions and low tolerance assessed by clinicians were received the single drug - capecitabine regimen for adjuvant chemotherapy after surgery. Outcome indicators: Overall survival (OS), Disease-free survival (DFS) and Cancer-specific survival (CSS). The follow-up was until March 2023. Length of hospital stay was defined as the interval from the admission date to the discharge date. The length of hospital stay after surgery was defined as the time from the date of surgery to the discharge date. OS was defined as the time interval from CRC surgery to death from any cause. DFS was defined as the interval from surgery to tumor recurrence, metastasis, or death. CSS was defined as time between CRC resection and death due to the cancer. 2.4 Statistical analyses R software and SPSS software were used for statistical analyses and visualization of data results. The baseline characteristics of COPD cohort and non-COPD cohort were compared by using the "stats" R package. T test or Wilcoxon test was used to compare measurement data between COPD cohort and non-COPD cohort. Chi-square tests or Fisher exact tests were used to analyze enumeration data. Moreover, in order to control the distribution of confounding factors and reduce their influence on the analysis of results, the propensity score matching module function of SPSS software was used to score for age, gender, BMI, cancer stage and tumor location in COPD and non-COPD cohorts with a sample ratio of 1:1 and a caliper value of 0.2. Kaplan-Meier survival curve was drawn by the "survival" R package and the "survminer" R package, and Log-rank test was performed to evaluate the overall differences in OS, CSS and DFS between two cohorts. The survival differences in the subgroup of CRC patients with COPD were analyzed andvisualized using the "ggplot2" R package. To observe whether there was a difference in the cumulative risk rate of tumor-related death between two cohorts after controlling for competitive risk events, the "cmprsk" R package was used to conduct Fine-Gray test analysis, establish a competitive risk model and calculate the cumulative death risk rate. Pearson correlation analysis was performed to evaluate the degree of correlation between TNM tumor stage and T stage, N stage and M stage. Univariate and multivariate Cox regression analyses were performed to screen factors affecting overall survival in CRC patients. P < 0.05 was considered statistically significant. 3. Results 3.1 Sociodemographic and clinical characteristics of CRC patients A total of 729 patients who underwent surgery for primary CRC in our hospital were enrolled in this study, including 58 patients in COPD cohort and 671 patients in non-COPD cohort. There were 48 (82.76%) males in COPD cohort and 376 (56.04%) males in non-COPD cohort, with statistically significant differences in the gender distribution between the two cohorts ( P < 0.0001). In addition, we found obvious statistical differences in the age, BMI, concomitant coronary heart disease, and smoking history between COPD and non-COPD cohorts ( P < 0.0001). There were no significant differences in concomitant diabetes mellitus, hypertension, alcohol consumption history, tumor location, TNM tumor stage, differentiated degree, histological type, maximum tumor diameter, neoadjuvant therapy and surgical time ( P > 0.05). (Table 1 ) Table 1 Clinical characteristics of CRC patients Characteristics COPD cohort (n = 58) Non-COPD cohort (n = 671) P Gender Male 48(82.76%) 376(56.04%) < 0.0001 Age(year) 73.5(69.25, 78) 62(54, 70) < 0.0001 BMI 19.92(18.54, 21.86) 22.67(20.57, 24.67) < 0.0001 Diabetes 6(10.34%) 86(12.82%) 0.587 Hypertension 19(32.76%) 199(29.66%) 0.621 Coronary heart disease 16(27.59%) 59(8.79%) < 0.0001 Smoking history 25(43.10%) 119(17.73%) < 0.0001 Alcohol consumption history 5(8.62%) 38(5.66%) 0.531 Tumor Location Rectum 15(25.86%) 195(29.06%) 0.606 Colon 43(74.14%) 476(70.94%) TNM tumor stage 0 stage 3(5.17%) 19(2.83%) 0.354 I stage 9(15.52%) 92(13.71%) II stage 25(43.10%) 227(33.83%) III stage 15(25.86%) 239(35.62%) IV stage 6(10.34%) 94(14.01%) Histological type Tubular adenocarcinoma 54(93.10%) 608(90.61%) 0.193 Mucinous adenocarcinoma + Signet-ring cell carcinoma 1(1.72%) 45(6.71%) Intramucosal carcinoma 3(5.17%) 18(2.68%) Differentiated degree High 1(1.72%) 21(3.13%) 0.858 Moderate 48(82.76%) 528(78.69%) Poor 5(8.62%) 61(9.09%) Other 4(6.90%) 61(9.09%) Maximum tumor diameter <5cm 29(50.00%) 405(60.36%) 0.123 ≥ 5cm 29(50.00%) 266(40.64%) Neoadjuvant therapy 6(10.34%) 87(12.97%) 0.566 Surgical time 2014–2019 29(50.00%) 295(43.96%) 0.375 2020–2022 29(50.00%) 376(56.04%) To accurately assess the difference in postoperative recovery and prognosis of CRC patients with and without COPD, we performed a propensity score for gender, age, BMI, TNM stage, and tumor location in both COPD and non-COPD cohorts to reduce the bias effect of confounders on the analysis result. After matching the two cohorts in a 1:1 ratio, 56 CRC patients with COPD and 56 CRC patients without COPD were included, including 46 men and 10 women in the COPD cohort and the same sex ratio in the paired control cohort. The median age was 73 (68.75, 78) years in the COPD cohort and 76 (66.75, 83.25) years in the non-COPD cohort. No obvious differences were observed between the paired COPD and non-COPD cohorts in the gender, age, BMI, concomitant diabetes mellitus, hypertension, coronary heart disease, bronchial asthma, smoking or drinking history, preoperative level of GI tumor indicators (CEA, AFR, CA199, CA724), tumor location, TNM stage, T stage, N stage, M stage, degree of differentiation, histological type, maximum tumor diameter, neoadjuvant therapy, operation year, operation method, operation timing, ASA score and postoperative adjuvant therapy ( P > 0.05). (Table 2 ) Table 2 Clinical characteristics of COPD cohort and non-COPD cohort after propensity matching analysis Characteristics COPD cohort (n = 56) Non-COPD cohort (n = 56) P Gender Male 46(82.14%) 46(82.14%) 1 Age (year) 73(68.75, 78) 76(66.75, 83.25) 0.331 BMI 20(18.85, 21.94) 20.83(19.02, 22.05) 0.386 Diabetes 5(8.93%) 7(12.50%) 0.541 Hypertension 18(32.14%) 21(37.50%) 0.552 Coronary heart disease 15(26.79%) 15(26.79%) 1 Bronchial asthma 6(10.71%) 1(1.79%) 0.118 Smoking history 24(42.86%) 24(42.86%) 1 Alcohol consumption history 5(8.93%) 9(16.07%) 0.253 Tumor location Rectum 14(25.00%) 14(25.00%) 1 Colon 42(75.00%) 42(75.00%) TNM stage 0 stage 2(3.57%) 3(5.36%) 0.777 I stage 9(16.07%) 6(10.71%) II stage 25(44.64%) 26(46.43%) III stage 14(25.00%) 15(26.79%) IV stage 6(10.71%) 6(10.71%) T stage 0 2(3.57%) 3(5.36%) 0.611 1 4(7.14%) 1(1.79%) 2 3(5.36%) 5(8.93%) 3 33(58.93%) 30(53.57%) 4 14(25.00%) 17(30.36%) N stage 0 36(64.29%) 33(58.93%) 0.520 1 15(26.79%) 14(25.00%) 2 5(8.93%) 9(16.07%) M stage 0 50(89.29%) 50(89.29%) 1 1 6(10.71%) 6(10.71%) Histological type Tubular adenocarcinoma 53(94.64%) 48(85.71%) 0.211 Mucinous adenocarcinoma + Signet-ring cell carcinoma 1(1.79%) 5(8.93%) Intramucosal carcinoma 2(3.57%) 3(5.36%) Differentiated degree High 1(1.79%) 1(1.79%) 0.464 Moderate 47(83.93%) 43(76.79%) Poor 5(8.93%) 4(7.14%) Other 3(5.36%) 8(14.29%) Maximum tumor diameter <5cm 27(48.21%) 33(58.93%) 0.256 ≥ 5cm 29(51.79%) 23(41.07%) Surgical time 2014–2019 28(50.00%) 31(55.36%) 1.000 2020–2022 28(50.00%) 25(44.64%) Surgical approach Laparoscopic 45(80.36%) 42(75.00%) 0.496 Open 11(19.64%) 14(25.00%) Intervention type Selevtive 55(98.21%) 53(94.64%) 0.611 Acute 1(1.79%) 3(5.36%) ASA grade I grade 0(0.00%) 1(1.79%) 0.120 II grade 26(46.43%) 27(48.21%) III grade 23(41.07%) 27(48.21%) IV grade 7(12.50%) 1(1.79%) Neoadjuvant therapy 6(10.71%) 6(10.71%) 1 Postoperative adjuvant therapy 18(32.14%) 16(28.57%) 0.681 Pre-operative CEA level(ng/ml) 5.7(3.31, 11.71) 4.69(2.86, 10.65) 0.468 Pre-operative AFP level(ng/ml) 2.88(2.02, 3.71) 2.76(2.14, 3.63) 0.895 Pre-operative CA199 level(U/ml) 16.92(11.12, 30.65) 18.22(8.63, 26.25) 0.527 Pre-operative CA724 level(U/ml) 1.79(1.15, 3.13) 1.85(1.17, 5.47) 0.480 3.2 Comparison of intraoperative and postoperative outcomes between the two cohorts After propensity matching, in COPD cohort, the operative duration was 4.17 (2.80, 5.18) hours, the anesthetic duration was 5.67 (4.31, 6.93) hours, the total length of hospital stay was 22 (17, 28.75) days, the duration of postoperative hospital stay was 11.5 (9, 16.75) days and the amount of intraoperative blood loss was 50 (30, 112.5) ml. In the non-COPD cohort, the operative duration was 4.42 (3.15, 5.36) hours, the anesthetic duration was 5.50 (4.58, 6.71) hours, the total length of hospital stay was 19 (16.75, 25) days, the duration of postoperative hospital stay was 10 (8, 14.5) days, and the intraoperative blood loss was 50 (45, 100) ml. There were no significant differences in these variables between the two cohorts (all P > 0.05). These results showed that COPD did not cause prolonged operation or anesthesia time, increased intraoperative blood loss, extended the length of hospital stay or postoperative hospital stay in CRC patients with COPD. (Table 3 ) Table 3 Comparison of surgical and postoperative outcomes between the two cohorts Characteristics COPD cohort ( n = 56) Non-COPD cohort ( n = 56) P Operative duration(h) 4.17 (2.80, 5.18) 4.42(3.15, 5.36) 0.256 Anaesthetics duration(h) 5.67 (4.31, 6.93) 5.50(4.58, 6.71) 0.993 Total length of hospital stay(d) 22(17, 28.75) 19(16.75, 25) 0.195 Duration of postoperative hospital stay(d) 11.5(9, 16.75) 10(8, 14.5) 0.145 Intraoperative blood loss(ml) 50(30, 112.5) 50(45, 100) 0.960 The time of postoperative abdominal drainage tube removal(d) 8(6, 10) 7(4.75, 9) 0.210 The time of postoperative urinary catheter removal(d) 5.5(4, 11) 4(3, 7) 0.039 The time of first postoperative defecation(d) 6.5(4.75, 9) 4(2.75, 6.25) < 0.001 ICU admission stay (d) < 0.001 0 17(30.36%) 43(76.79%) 1 ~ 2 16(28.57%) 7(12.50%) 3 ~ 5 12(21.43%) 5(8.93%) 6 or more 11(19.64%) 1(1.79%) Antibiotic use 0.035 First and second generation cephalosporins 27(48.2%) 38(67.9%) Carbapenems, third generation cephalosporins 29(51.8%) 18(32.1%) Postoperative transfusion 11(19.64%) 9(16.07%) 0.622 glucocorticoid 5(8.93%) 0(0.00%) 0.067 secondary operation 2(3.57%) 0(0.00%) 0.476 Non-invasive assisted ventilation 11(19.64%) 0(0.00%) < 0.001 Invasive assisted ventilation 17(30.36%) 4(7.14%) 0.002 Fiberoptic bronchoscopy 6(10.71%) 0(0.00%) 0.036 Hemodialysis 1(1.79%) 0(0.00%) 1.000 Intravenous pressor/vasoconstrictor 6(10.71%) 2(3.57%) 0.271 Wound Infection 2(3.57%) 0(0.00%) 0.476 Incision dehiscence 2(3.57%) 2(3.57%) 1.000 Pneumonia 17(30.36%) 5(8.93%) 0.004 Abdominal infection 8(14.29%) 3(5.36%) 0.112 Catheter-related infection 1(1.79%) 0(0.00%) 1 Urinary tract infection 0(0.00%) 1(1.79%) 1.000 Septic shock 6(10.71%) 0(0.00%) 0.036 Hypovolemic shock 2(3.57%) 0(0.00%) 0.476 Respiratory failure 4(7.14%) 1(1.79%) 0.360 Heart failure 1(1.79%) 0(0.00%) 1 intestinal obstruction 4(7.14%) 0(0.00%) 0.127 Anastomotic leakage 0(0.00%) 2(3.57%) 0.476 Anastomotic hemorrhage 3(5.36%) 1(1.79%) 0.611 Acute kidney injury 2(3.57%) 0(0.00%) 0.476 After CRC resection, in COPD cohort, the time of abdominal drainage tube removal was 8 (6,10) days, the time of urinary catheter removal was 5.5 (4,11) days and the time of first defecation was 6.5 (4.75,9) days. In the paired non-COPD cohort, the time of abdominal drainage tube removal was 7 (4.75, 9) days, the time of urinary catheter removal was 4 (3, 7) days, and the time of first defecation was 4 (2.75, 6.25) days. The results demonstrated that the time of postoperative urinary catheter removal and the time of first defecation after surgery in CRC patients with COPD were longer than that in CRC patients without COPD (all P < 0.05). However, there was no statistical differences in the time of postoperative abdominal drainage tube removal between the two cohorts. (Table 3 ) Furthermore, ICU admission rate after surgery was 69.64% in COPD cohort, whereas ICU admission rate was only 23.21% in non-COPD cohort, with a statistically significant difference ( P < 0.001). In the COPD cohort, 11 patients (19.64%) stayed in ICU for 6 days or more, 12 patients (21.43%) stayed in ICU for 3 to 5 days, and 16 patients (28.57%) stayed in ICU for 1 to 2 days. In the non-COPD cohort, only 1 (1.79%) patient stayed in ICU for more than 6 days, 5 patients stayed in ICU for 3 to 5 days, and 7 patients stayed in ICU for 1 to 2 days. Moreover, non-invasive assisted ventilation rates were 19.64% and 0%, invasive assisted ventilation rates were 30.36% and 7.14%, and fiberoptic bronchoscopy rates were 10.71% and 0% in the COPD cohort and in the non-COPD cohort, respectiely. However, no statistical differences were observed in postoperative blood transfusion rate, glucocorticoid utilization rate, secondary operation rate, hemodialysis rate, and the utilization rate of intravenous pressor or vasoconstrictor between 2 cohorts ( P > 0.05). In the use of antibiotics, we found that the usage of postoperative high-grade antibiotics such as carbapenems and third-generation cephalosporin in COPD cohort was more more common than that in non-COPD cohort (Table 3 ). The results indicate that CRC patients with COPD need more intensive care, more assisted ventilation and high-grade antibiotics after surgery. We compared the postoperative complications between COPD cohort and non-COPD cohort and found that a greater proportion of patients developed pneumonia and septic shock after CRC resection in COPD cohort than non-COPD cohort. However, there were no statistically significant differences in the incidence of wound infection, incision dehiscence, abdominal infection, catheter associated infection, urinary tract infection, hypovolemic shock, respiratory failure, heart failure, intestinal obstruction, anastomotic leakage, anastomotic hemorrhage, and acute kidney injury after surgery between the two cohorts (all P > 0.05). (Table 3 ) 3.3 Postoperative overall survival was worse in COPD cohort To accurately assess the impact of COPD on the prognosis of CRC patients after surgery, we conducted survival correlation analysis in the 112 CRC patients. Our results showed that postoperative overall survival of patients was worse in COPD cohort than that in non-COPD cohort ( P = 0.043) (Fig. 1 A). However, we found no obvious differences in DFS (Fig. 1 B) and CSS (Fig. 1 C) between COPD and non-COPD cohorts. A) Overall postoperative survival curve of patients in COPD group and non-COPD group;B) Postoperative disease-free survival curve of patients in COPD group and non-COPD group; C) Postoperative cancer-specific survival curves of patients in COPD group and non-COPD group; To explore the effect of neoplastic and other prognostic outcomes on the prognosis of CRC patients, we defined other death causes as non-neoplastic causes, such as severe pneumonia, other comorbidity. A competition risk model was established to determine whether there was a difference in cancer-specific death risk of patients between COPD and non-COPD cohorts. The results confirmed that no distinct difference in the risk of cancer-related death between COPD and non-COPD cohorts after controlling for competing risks of non-neoplastic causes (Fig. 2 ). CIF: Cumulative incidence function. Red : Cumulative incidence (curve) of non-tumor causes of death in COPD group; Blue: Cumulative incidence (curve) of non-tumor causes of death in non-COPD group; Black : Cumulative incidence (curve) of death from CRC in COPD group; Green : Cumulative incidence (curve) of death from CRC in non-COPD group. 3.4 COPD was an independent factor for overall survival of CRC patients Univariate COX regression analysis showed that COPD, TNM stages, N stage, M stage, nerve invasion, surgical approach, ASA grade, preoperative CEA level, preoperative CA199 level, preoperative CA724 level and postoperative adjuvant therapy were correlated with overall survival of CRC patients (P < 0.05). However, age, sex, BMI, maximum tumor diameter, T-stage, tumor location, differentiated degree, histological type, surgical time, surgical year, diabetes, hypertension, coronary heart disease, bronchial asthma, smoking and alcohol consumption history, and neoadjuvant therapy were not associated with overall survival ( P > 0.05). (Table 4 ) Table 4 Univariate analysis of overall survival in patients with CRC Characteristics HR 95% CI P COPD No 1 Yes 1.832 1.012–3.311 0.046 Age(year) 1.021 0.990–1.054 0.189 Gender Male 1 Female 0.814 0.377–1.757 0.6 BMI(kg/m2) 0.896 0.794–1.011 0.075 Maximum tumor diameter(cm) <5 1 ≥ 5 1.459 0.806–2.643 0.212 TNM tumor stage IV 1 III 0.356 0.165–0.767 0.008 II 0.107 0.046–0.249 < 0.001 0-I 0.101 0.031–0.329 < 0.001 T stage 3–4 1 1–2 0.416 0.101–1.724 0.227 0 0.633 0.087–4.624 0.652 N stage 0 1 1 2.965 1.506–5.838 0.002 2 3.996 1.852–8.620 < 0.001 M stage 0 1 1 5.771 2.854–11.667 < 0.001 Tumor location Rectum 1 Colon 0.832 0.411–1.686 0.61 Differentiated degree Moderate + High 1 Poor 1.217 0.465–3.185 0.689 other 1.215 0.509-2.900 0.661 Histological type Tubular adenocarcinoma 1 Mucinous adenocarcinoma + Signet-ring cell carcinoma 1.255 0.387–4.073 0.705 Intramucosal carcinoma 1.508 0.361–6.296 0.573 Nerve invasion No 1 Yes 2.241 1.151–4.361 0.018 Vascular infiltration No 1 Yes 1.74 0.953–3.175 0.071 Surgical approach Laparoscopic 1 Open 2.049 1.097–3.827 0.024 Intervention type Selevtive 1 Acute 1.649 0.397–6.854 0.491 Surgical time 2014–2019 1 2020–2022 1.735 0.819–3.676 0.151 ASA grade I-II 1 III-IV 2.031 1.109–3.722 0.022 Diabetes No 1 Yes 0.561 0.199–1.587 0.276 Hypertension No 1 Yes 1.041 0.557–1.943 0.9 Coronary heart disease No 1 Yes 1.615 0.852–3.060 0.142 Bronchial asthma No 1 Yes 0.761 0.235–2.470 0.65 Smoking history No 1 Yes 0.989 0.549–1.783 0.971 Alcohol consumption history No 1 Yes 0.598 0.234–1.528 0.283 Pre-operative CEA level(ng/ml) <5 1 ≥ 5 2.074 1.098–3.915 0.025 Pre-operative CA199 level(U/ml) <39 1 ≥ 39 2.556 1.300-5.026 0.007 Pre-operative CA724 level(U/ml) <6.9 1 ≥ 6.9 2.237 1.120–4.469 0.023 Neoadjuvant therapy No 1 Yes 0.528 0.128–2.185 0.378 Postoperative adjuvant therapy No 1 Yes 0.406 0.195–0.846 0.016 Since Pearson's correlation test suggested obvious collinearity between TNM stages and N stage (correlation coefficient = 0.704, P < 0.001) and M stage (correlation coefficient = 0.669, P < 0.001), only TNM stages was included in the multivariate analysis. Multivariate COX regression analysis showed that COPD (HR = 3.232, 95%CI: 1.537–6.795, P = 0.002) and TNM stages (Stage III vs. stage IV, HR = 0.261, 95%CI: 0.099–0.687, P = 0.007; Stage II vs. Stage IV, HR = 0.129, 95%CI: 0.046–0.360, P < 0.001; Stage 0-I vs. stage IV, HR = 0.104, 95%CI: 0.025–0.430, P = 0.002) were independent prognostic factors in CRC patients (Fig. 3 ). 4. Discussion In this study, we found that COPD and TNM stages were independent risk factors for overall survival of postoperative CRC patients, which is similar to the previous studies[ 17 – 19 , 22 , 23 ]. However, COPD was not associated with postoperative CSS or DFS in CRC patients. Furthermore, our results demonstrated that COPD was correlated with more postoperative complications. Surgical resection is the only potentially curative modality for localized CRC. Laparoscopic CRC resection is generally considered a safe and feasible treatment modality for CRC patients, especially for elderly CRC patients [ 24 – 26 ]. General anesthesia with endotracheal intubation is the mainstream anesthesia method for most laparoscopic CRC resection. During laparoscopic surgery, pneumoperitoneum is always established by aerating the abdominal cavity with carbon dioxide to provide sufficient surgical field of view. Pneumoperitoneum can lead to decreased lung volume, increased peak airflow pressure, and decreased lung compliance. Moreover, upward displacement of the diaphragm makes it easier for ventilator-perfusion mismatch with more severe intrapulmonary shunt [ 27 , 28 ]. Thus, CRC patients with COPD pose challenges for both surgery and anesthesia. We found that CRC patients with COPD were more prone to postoperative pneumonia, septic shock, and the use of high-grade antibiotics, non-invasive assisted ventilation, invasive assisted ventilation, ICU admission, fiberoptic bronchoscopy compared with CRC patients without COPD. Furthermore, we found distinct differences in ICU admission between COPD and non-COPD patients and markedly prolonged postoperative ICU stay days in CRC patients with COPD. The reason why COPD patients need more ICU care after surgery might be associated with their poor pulmonary function or poor physical tolerance or more postoperative complication. In addition, we found that COPD patients had longer postoperative time of catheter removal and bowel recovery. However, there was no striking difference in overall hospital stay or postoperative hospital stay between the two cohorts. These results suggests that surgical resection is recommended for CRC patients with COPD and that CRC patients with COPD need more intensive postoperative care. In this study, we found that COPD was an independent risk factor for OS of CRC patients, but COPD was not associated with postoperative CSS or DFS in CRC patients. The results indicate that COPD is a very important factor which influences overall survival and that COPD doesn’t accelerate cancer recurrence and metastasis in CRC patients. Therefore, surgical resection is recommended for selective CRC patients with COPD under the condition of more intensive postoperative care. Taken together, our results demonstrated that COPD was an independent risk factor for the overall survival of CRC patients and was correlated with more postoperative complications. However, COPD was not associated with postoperative CSS or DFS of CRC patients. The results suggest surgical resection is recommended for selective CRC patients with COPD under the condition of more intensive postoperative care. Declarations Conflict of interest The authors have no conflicts of interest to disclose. Author Contribution All authors took part in designing the study, selection criteria, discussion, paper writing, and final approval of the article. JQ Wang, XE Zhang, GM Chen,YX Wu, X Yang and ZR Li contributed to data collection, statistical analyses, and table/figures manufacture. JX Chen contributed to double checking of included studies, quality assessment, and bias assessment. XE Zhang and JS Chen contributed to the paper revision. JS Chen finished the final checking of all content in this paper. Acknowledgement This work was supported by grants from the National Natural Science Foundation of China (82072620), GuangDong Basic and Applied Basic Research Foundation (2021A1515011357) and Guangzhou Municipal Science and Technology Project (202102010158). References SUNG H, FERLAY J, SIEGEL R L, LAVERSANNE M, SOERJOMATARAM I, JEMAL A, BRAY F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3): 209–49. Cancer stat facts: colorectal cancer. National Cancer Institute. Available at: https://seer.cancer.gov/statfacts/html/colorect.html . Accessed March 20, 2023. WIDDISON A L, BARNETT S W, BETAMBEAU N. The impact of age on outcome after surgery for colorectal adenocarcinoma. Ann R Coll Surg Engl, 2011, 93(6): 445–50. Global Strategy for the Diagnosis, Management and Prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023.Available at: https://goldcopd.org/2023-gold-report-2/ . Accessed March 20, 2023. RUTTEN E P A, LENAERTS K, BUURMAN W A, WOUTERS E F M. Disturbed intestinal integrity in patients with COPD: effects of activities of daily living. Chest, 2014, 145(2): 245–52. RUTTEN E P, SPRUIT M A, FRANSSEN F M, BUURMAN W A, WOUTERS E F, LENAERTS K. GI symptoms in patients with COPD. Chest, 2014, 145(6): 1437–8. LEE J, IM J P, HAN K, PARK S, SOH H, CHOI K, KIM J, CHUN J, KIM J S. Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study. World J Gastroenterol, 2019, 25(42): 6354–64. NIELSEN H M, RODSGAARD P A, WEINREICH U M. Chronic obstructive pulmonary disease as comorbidity in patients admitted to a university hospital: a cross-sectional study. Clin Respir J, 2014, 8(3): 274–80. CHUN E M, KIM S W, LIM S Y. Prevalence of colorectal adenomatous polyps in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2015, 10: 955–60. Ahn, S. V., et al. (2020). Cancer development in patients with COPD: a retrospective analysis of the National Health Insurance Service-National Sample Cohort in Korea. BMC Pulm Med 2020, 20(1): 170. COLGAN S P, TAYLOR C T. Hypoxia: an alarm signal during intestinal inflammation. Nat Rev Gastroenterol Hepatol, 2010, 7(5): 281–7. XIN X, DAI W, WU J, FANG L, ZHAO M, ZHANG P, CHEN M. Mechanism of intestinal mucosal barrier dysfunction in a rat model of chronic obstructive pulmonary disease: An observational study. Exp Ther Med, 2016, 12(3): 1331–6. KARADAG F, KIRDAR S, KARUL A B, CEYLAN E. The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med, 2008, 19(2): 104–8. SPROOTEN R T M, LENAERTS K, BRAEKEN D C W, GRIMBERGEN I, RUTTEN E P, WOUTERS E F M, ROHDE G G U. Increased Small Intestinal Permeability during Severe Acute Exacerbations of COPD. Respiration, 2018, 95(5): 334–42. CHEN J, YIN Y, ZHANG Y, LIN X, CHEN T, YANG Z, WANG D, ZHONG W. Chronic Obstructive Pulmonary Disease Prevalence and Associated Risk Factors in Adults Aged 40 Years and Older in Southeast China: A Cross-Sectional Study During 2019–2020. Int J Chron Obstruct Pulmon Dis, 2022, 17: 2317–28. FIELDS A C, DIVINO C M. Surgical outcomes in patients with chronic obstructive pulmonary disease undergoing abdominal operations: An analysis of 331,425 patients. Surgery, 2016, 159(4): 1210–6. BARE M, MONTON C, MORA L, REDONDO M, PONT M, ESCOBAR A, SARASQUETA C, FERNANDEZ DE LARREA N, BRIONES E, QUINTANA J M. COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1233–41. CHENG W J, CHIANG C C, PENG M T, HUANG Y T, HUANG J L, CHANG S H, YANG H T, CHEN W C, KUO J J, HWANG T L. Chronic Obstructive Pulmonary Disease Increases the Risk of Mortality among Patients with Colorectal Cancer: A Nationwide Population-Based Retrospective Cohort Study. Int J Environ Res Public Health, 2021, 18(16). PLATON A M, ERICHSEN R, CHRISTIANSEN C F, ANDERSEN L K, SVAERKE C, MONTOMOLI J, SORENSEN H T. The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery: a Danish population-based cohort study. BMJ Open Respir Res, 2014, 1(1): e000036. LEMMENS V E, JANSSEN-HEIJNEN M L, HOUTERMAN S, VERHEIJ K D, MARTIJN H, VAN DE POLL-FRANSE L, COEBERGH J W. Which comorbid conditions predict complications after surgery for colorectal cancer? World J Surg, 2007, 31(1): 192–9. GUPTA H, RAMANAN B, GUPTA P K, FANG X, POLICH A, MODRYKAMIEN A, SCHULLER D, MORROW L E. Impact of COPD on postoperative outcomes: results from a national database. Chest, 2013, 143(6): 1599–606. CHEN Y C, LI M C, YU Y H, LIN C M, WU S Y. Chronic Obstructive Pulmonary Disease and Its Acute Exacerbation before Colon Adenocarcinoma Treatment Are Associated with Higher Mortality: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study. Cancers (Basel), 2021, 13(18). ZHANG J, CHIU K C, LIN W C, WU S Y. Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study. Cancers (Basel), 2021, 13(16). DEVOTO L, CELENTANO V, COHEN R, KHAN J, CHAND M. Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. Int J Colorectal Dis, 2017, 32(9): 1237–42. NISHIKAWA T, KAWAI K, EMOTO S, MURONO K, HIYOSHI M, KANEKO M, SONODA H, SASAKI K, SHUNO Y, TANAKA T, HATA K, NOZAWA H. The influence of pulmonary comorbidities on treatment choice and short-term surgical outcomes among elderly patients with colorectal cancer. Int J Colorectal Dis, 2019, 34(8): 1497–501. PETERSSON J, MATTHIESSEN P, JADID K D, BOCK D, ANGENETE E. Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open. Sci Rep, 2023, 13(1): 4335. KHETARPAL R, BALI K, CHATRATH V, BANSAL D. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries. Anesth Essays Res, 2016, 10(1): 7–12. GRABOWSKI J E, TALAMINI M A. Physiological effects of pneumoperitoneum. J Gastrointest Surg, 2009, 13(5): 1009–16. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4590558","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":316789032,"identity":"41218da1-d4a9-4972-b3c5-cf5fdcdb2418","order_by":0,"name":"Jian-Qi Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jian-Qi","middleName":"","lastName":"Wang","suffix":""},{"id":316789038,"identity":"60f11c15-1fd4-4118-9fa8-de11ae5d0505","order_by":1,"name":"Xin-er Zhang","email":"","orcid":"","institution":"The First Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xin-er","middleName":"","lastName":"Zhang","suffix":""},{"id":316789039,"identity":"2f92f0a9-8c7c-43da-9c7c-de31f30a9aa1","order_by":2,"name":"Gao-ming Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Gao-ming","middleName":"","lastName":"Chen","suffix":""},{"id":316789040,"identity":"9230f87e-02c0-4035-8826-ad1ffc55f87e","order_by":3,"name":"Yi-xiang Wu","email":"","orcid":"","institution":"The First Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yi-xiang","middleName":"","lastName":"Wu","suffix":""},{"id":316789042,"identity":"41568503-7f9d-43bf-855d-57749ce26d5e","order_by":4,"name":"Xiao Yang","email":"","orcid":"","institution":"The First Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"","lastName":"Yang","suffix":""},{"id":316789048,"identity":"6502277c-93f4-4d50-9fe1-9ef8675d244a","order_by":5,"name":"Ze-Rong Li","email":"","orcid":"","institution":"The First Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ze-Rong","middleName":"","lastName":"Li","suffix":""},{"id":316789049,"identity":"8f361b81-2988-4106-8f69-e6406cb0f1b7","order_by":6,"name":"Jin-Xu Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jin-Xu","middleName":"","lastName":"Chen","suffix":""},{"id":316789050,"identity":"177a77d3-da08-47ef-ba57-5aae7385c318","order_by":7,"name":"Jin-Song Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYBACAwYGNgYQ5mdmPviANC2S7WzJBqRoATLO85gJEKXFXCL52YOPO/jsjQ8zmDEw1NhEE9RiOSPN3HDmGbbEbYcZ0h4wHEvLbSDosBs5bNK8bWwJZocZjhswNhwmUsvfNjZ742bGNgnitTC2sTFuYGZmI1LLmWdmkr1tbIkzDrMxGyQQ5Zfjyc8kfrYds+fvP//xwYcaG8JaGAQSQOQxCCeBoHIQ4D8AImuIUjsKRsEoGAUjFAAA6CQ74YNyBTIAAAAASUVORK5CYII=","orcid":"","institution":"The First Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jin-Song","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-06-16 17:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4590558/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4590558/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60605488,"identity":"a15e8739-de6a-4b92-be4d-2ebb2db3cb3c","added_by":"auto","created_at":"2024-07-18 16:49:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50456,"visible":true,"origin":"","legend":"\u003cp\u003eSurvival curves after CRC resection in patients with and without COPD.\u003c/p\u003e\n\u003cp\u003eA) Overall postoperative survival curve of patients in COPD group and non-COPD group;B) Postoperative disease-free survival curve of patients in COPD group and non-COPD group; C) Postoperative cancer-specific survival curves of patients in COPD group and non-COPD group;\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590558/v1/094dabfdd9d65b8dd9fc2738.jpg"},{"id":60605165,"identity":"6b1e051c-d7f6-45f2-a795-540fa3db8fd9","added_by":"auto","created_at":"2024-07-18 16:41:46","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39877,"visible":true,"origin":"","legend":"\u003cp\u003eCompeting risk models of mortality events in COPD versus non-COPD groups.\u003c/p\u003e\n\u003cp\u003eCIF: Cumulative incidence function. Red : Cumulative incidence (curve) of non-tumor causes of death in COPD group; Blue: Cumulative incidence (curve) of non-tumor causes of death in non-COPD group; Black : Cumulative incidence (curve) of death from CRC in COPD group; Green : Cumulative incidence (curve) of death from CRC in non-COPD group.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590558/v1/e597310be6ab66e14b58d1d7.jpg"},{"id":60605167,"identity":"8045f8ac-9ab2-4beb-afa5-77b019dfa97f","added_by":"auto","created_at":"2024-07-18 16:41:47","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":81387,"visible":true,"origin":"","legend":"\u003cp\u003eForest chart of multivariate COX regression analysis for overall survival of CRC patients\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4590558/v1/188e001b0fa9d0efafd2a8a6.jpg"},{"id":63662917,"identity":"d9b5b09d-9141-4eb4-94bf-08f904eb2689","added_by":"auto","created_at":"2024-08-30 18:41:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1270324,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4590558/v1/77e41c5f-0378-4300-bb82-9f40f00b7c67.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Chronic Obstructive Pulmonary Disease on surgical outcomes of Patients with Colorectal cancer","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eColorectal Cancer (CRC) is one of the most common solid malignant tumors and the second largest cause of cancer-related death in the world. In 2020, there were 1.88\u0026nbsp;million new cases of CRC, accounting for 9.7% of all malignancies, and 916,000 deaths, taking up 9.2% of all malignancies [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the latest statistics, more than half of the CRC patients are newly diagnosed at 65 years and above [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Surgical resection is the mainstay of treatment for localized CRC. However, the increase of age and the growing number of comorbidities are contributed to poorer prognosis after surgery in CRC patients [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, major challenges have been posed to surgeons for elderly CRC patients with comorbidities during the perioperative period.\u003c/p\u003e \u003cp\u003eChronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases in the world, with a high disability and mortality rate, which brings about long-term life troubles and economic burdens to patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. COPD is a systemic disease that, in addition to irreversible airflow limitation changes in the lungs, can adversely affect vital organs other than the lungs, such as the intestines [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Previous studies have shown that COPD patients are more likely to experience gastrointestinal (GI) symptoms, have a higher prevalence of GI disorders, and are more likely to receive treatment for intestinal disorders [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Previous study has shown that the incidence of colorectal adenomatous polyps is significantly higher in COPD patients than healthy people [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. COPD is a risk factor for colorectal adenomatous polyps and the development of CRC[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The underlying mechanisms might be related to changes in intestinal permeability and loss of barrier function caused by tissue hypoxia, chronic inflammatory reaction and autonomic nervous dysfunction [\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost CRC patients are diagnosed at a relatively advanced age when chronic comorbidities including COPD often co-exist [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. For elderly CRC patients with COPD, surgery may be the best treatment modality. However, these patients often have various lung function limitations, which can lead to decreased tolerance to surgery and increased incidence of postoperative complications [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. It has been reported that CRC patients with COPD had poorer survival than those without COPD after CRC resection [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In addition, relevant studies from different regions have indicated that the prevalence of postoperative pneumonia in patients with COPD is higher than that in those without COPD [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, the reports on perioperative prognosis and overall survival of patients with or without COPD are inconsistent. Surgery for patients with COPD often brings vast challenges to surgeons because they need to comprehensively assess the benefits and relevant risks of surgery before developing clinical proposals. Nevertheless, effective reference basis for the clinical proposals is very limited.\u003c/p\u003e \u003cp\u003eThis study retrospectively analyzed the clinical data of patients undergoing CRC surgery in our center, and further explored the influence of COPD on the CRC patients during the perioperative period to provide more clinical references for surgical treatment of CRC patients with COPD.\u003c/p\u003e"},{"header":"2. Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Patients\u003c/h2\u003e \u003cp\u003eIn this study, clinical data were retrospectively collected from the patients who underwent colorectal resection for primary CRC from January 2014 to December 2022 in our hospital. All patients were followed-up by a review of the electronic outpatient and inpatient records and telephone.\u003c/p\u003e \u003cp\u003eAccording to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), patients with a FEV1/FVC ratio of less than 0.70 following bronchodilator inhalation on lung function tests are diagnosed as having COPD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Thus, the patients included in the study were divided into two cohorts: COPD cohort (those with COPD) and non-COPD cohort ( those without COPD).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Inclusion and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eInclusion criteria for this study were: 1) Patients received CRC resection; 2) Postoperative pathological findings confirmed primary CRC, including tubular adenocarcinoma, mucinous adenocarcinoma, signet-ring cell carcinoma, and intramucosal carcinoma; 3) Age over 18 years old; 4) Complete clinical information (including patient general information, preoperative related blood test, surgery related data, postoperative pathological information, etc.). 5) All enrolled patients had signed informed consent, and the agreement was reviewed and approved by the Ethics Committee.\u003c/p\u003e \u003cp\u003eExclusion Criteria for this study were: 1) Patients with multiple primary CRC or other severe comorbidity; 2) Patients with concomitant or previous other primary malignancies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Variables and Data Collection\u003c/h2\u003e \u003cp\u003eData on the following clinical variables were collected in detail from electronic clinical records or telephone interviews with patients and families using structured questionnaires and manuals by appropriately trained investigators:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGeneral information of the patient: age, sex, body mass index (BMI), smoking and alcohol consumption history, diabetes, hypertension, coronary heart disease, admission and discharge date;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePreoperative serum GI tumor indicators: Carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), Carbohydrate antigen (CA) 199 and CA724 levels;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eInformation about CRC surgery: American Society of Anesthesiologists (ASA) score (grades I to IV), date of surgery, operation timing, method of surgery, operative duration, anesthetic duration, intraoperative blood loss, and intraoperative blood transfusion;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTumor status: maximum tumor diameter, pathological TNM tumor stage (AJCC 8th Edition), tumor location, differentiated degree, histological type, nerve invasion, and vessel carcinoma embolus;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePostoperative treatment related information: ICU stay days, abdominal drainage tube removal time, urinary tube removal time, first defecation time, antibiotic use, postoperative blood transfusion, glucocorticoid use, rescue times and reasons, assisted ventilation, invasive assisted ventilation, hemodialysis, intravenous pressor or vasoconstrictor use;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIncidence of complications: pneumonia, wound infection, incision dehiscence, intestinal obstruction, abdominal infection, urinary tract infection, septic shock, hypovolemic shock, respiratory failure, acute heart failure, anastomotic leakage, anastomotic bleeding, acute kidney injury and catheter-related complications, etc;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe selection of neoadjuvant chemotherapy regimens was generally similar to postoperative adjuvant chemotherapy regimens (FOLFOX regimen (oxaliplatin\u0026thinsp;+\u0026thinsp;fluorouracil) or CapeOX regimen (oxaliplatin\u0026thinsp;+\u0026thinsp;capecitabine)). If chemotherapy was effective to advanced CRC, further surgery was performed and the original chemotherapy regimen was continued after surgery. Patients with poor physical conditions and low tolerance assessed by clinicians were received the single drug - capecitabine regimen for adjuvant chemotherapy after surgery.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cli\u003e\u003cp\u003eOutcome indicators: Overall survival (OS), Disease-free survival (DFS) and Cancer-specific survival (CSS).\u003c/p\u003e\u003c/li\u003e\u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e\n \u003cp\u003eThe follow-up was until March 2023. Length of hospital stay was defined as the interval from the admission date to the discharge date. The length of hospital stay after surgery was defined as the time from the date of surgery to the discharge date. OS was defined as the time interval from CRC surgery to death from any cause. DFS was defined as the interval from surgery to tumor recurrence, metastasis, or death. CSS was defined as time between CRC resection and death due to the cancer.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analyses\u003c/h2\u003e \u003cp\u003eR software and SPSS software were used for statistical analyses and visualization of data results. The baseline characteristics of COPD cohort and non-COPD cohort were compared by using the \"stats\" R package. T test or Wilcoxon test was used to compare measurement data between COPD cohort and non-COPD cohort. Chi-square tests or Fisher exact tests were used to analyze enumeration data. Moreover, in order to control the distribution of confounding factors and reduce their influence on the analysis of results, the propensity score matching module function of SPSS software was used to score for age, gender, BMI, cancer stage and tumor location in COPD and non-COPD cohorts with a sample ratio of 1:1 and a caliper value of 0.2. Kaplan-Meier survival curve was drawn by the \"survival\" R package and the \"survminer\" R package, and Log-rank test was performed to evaluate the overall differences in OS, CSS and DFS between two cohorts. The survival differences in the subgroup of CRC patients with COPD were analyzed andvisualized using the \"ggplot2\" R package. To observe whether there was a difference in the cumulative risk rate of tumor-related death between two cohorts after controlling for competitive risk events, the \"cmprsk\" R package was used to conduct Fine-Gray test analysis, establish a competitive risk model and calculate the cumulative death risk rate. Pearson correlation analysis was performed to evaluate the degree of correlation between TNM tumor stage and T stage, N stage and M stage. Univariate and multivariate Cox regression analyses were performed to screen factors affecting overall survival in CRC patients. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Sociodemographic and clinical characteristics of CRC patients\u003c/h2\u003e \u003cp\u003eA total of 729 patients who underwent surgery for primary CRC in our hospital were enrolled in this study, including 58 patients in COPD cohort and 671 patients in non-COPD cohort. There were 48 (82.76%) males in COPD cohort and 376 (56.04%) males in non-COPD cohort, with statistically significant differences in the gender distribution between the two cohorts (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In addition, we found obvious statistical differences in the age, BMI, concomitant coronary heart disease, and smoking history between COPD and non-COPD cohorts (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). There were no significant differences in concomitant diabetes mellitus, hypertension, alcohol consumption history, tumor location, TNM tumor stage, differentiated degree, histological type, maximum tumor diameter, neoadjuvant therapy and surgical time (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of CRC patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCOPD cohort\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-COPD cohort\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;671)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48(82.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e376(56.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73.5(69.25, 78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62(54, 70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.92(18.54, 21.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.67(20.57, 24.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(10.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86(12.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19(32.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e199(29.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(27.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59(8.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(43.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e119(17.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(8.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38(5.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor Location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(25.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e195(29.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(74.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e476(70.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNM\u003c/p\u003e \u003cp\u003etumor\u003c/p\u003e \u003cp\u003estage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(5.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(2.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(15.52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92(13.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(43.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e227(33.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(25.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e239(35.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIV stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(10.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94(14.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistological type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTubular adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54(93.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e608(90.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMucinous adenocarcinoma\u0026thinsp;+\u0026thinsp;Signet-ring cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(6.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntramucosal carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(5.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(2.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferentiated degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(3.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48(82.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e528(78.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(8.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(9.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(6.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61(9.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum tumor\u003c/p\u003e \u003cp\u003ediameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e405(60.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e266(40.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(10.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87(12.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014\u0026ndash;2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e295(43.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e376(56.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo accurately assess the difference in postoperative recovery and prognosis of CRC patients with and without COPD, we performed a propensity score for gender, age, BMI, TNM stage, and tumor location in both COPD and non-COPD cohorts to reduce the bias effect of confounders on the analysis result. After matching the two cohorts in a 1:1 ratio, 56 CRC patients with COPD and 56 CRC patients without COPD were included, including 46 men and 10 women in the COPD cohort and the same sex ratio in the paired control cohort. The median age was 73 (68.75, 78) years in the COPD cohort and 76 (66.75, 83.25) years in the non-COPD cohort. No obvious differences were observed between the paired COPD and non-COPD cohorts in the gender, age, BMI, concomitant diabetes mellitus, hypertension, coronary heart disease, bronchial asthma, smoking or drinking history, preoperative level of GI tumor indicators (CEA, AFR, CA199, CA724), tumor location, TNM stage, T stage, N stage, M stage, degree of differentiation, histological type, maximum tumor diameter, neoadjuvant therapy, operation year, operation method, operation timing, ASA score and postoperative adjuvant therapy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of COPD cohort and non-COPD cohort after propensity matching analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCOPD cohort\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-COPD cohort\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(82.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46(82.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73(68.75, 78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e76(66.75, 83.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(18.85, 21.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.83(19.02, 22.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7(12.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.541\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(32.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21(37.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(26.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15(26.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchial asthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(42.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24(42.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9(16.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42(75.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42(75.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNM stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(16.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25(44.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26(46.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15(26.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIV stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(7.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(58.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30(53.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(30.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36(64.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33(58.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(26.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9(16.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50(89.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50(89.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistological type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTubular adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53(94.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48(85.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMucinous adenocarcinoma\u0026thinsp;+\u0026thinsp;Signet-ring cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntramucosal carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferentiated degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47(83.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43(76.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4(7.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8(14.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003cp\u003etumor\u003c/p\u003e \u003cp\u003ediameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27(48.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33(58.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(51.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23(41.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2014\u0026ndash;2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31(55.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28(50.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(44.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003cp\u003eapproach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparoscopic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45(80.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42(75.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(19.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14(25.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelevtive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55(98.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53(94.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26(46.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27(48.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(41.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27(48.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIV grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(12.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003eadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(32.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(28.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operative CEA level(ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.7(3.31, 11.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.69(2.86, 10.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operative AFP level(ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.88(2.02, 3.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.76(2.14, 3.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operative CA199 level(U/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.92(11.12, 30.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.22(8.63, 26.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operative CA724 level(U/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.79(1.15, 3.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.85(1.17, 5.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.480\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e3.2 Comparison of intraoperative and postoperative outcomes between the two cohorts\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eAfter propensity matching, in COPD cohort, the operative duration was 4.17 (2.80, 5.18) hours, the anesthetic duration was 5.67 (4.31, 6.93) hours, the total length of hospital stay was 22 (17, 28.75) days, the duration of postoperative hospital stay was 11.5 (9, 16.75) days and the amount of intraoperative blood loss was 50 (30, 112.5) ml. In the non-COPD cohort, the operative duration was 4.42 (3.15, 5.36) hours, the anesthetic duration was 5.50 (4.58, 6.71) hours, the total length of hospital stay was 19 (16.75, 25) days, the duration of postoperative hospital stay was 10 (8, 14.5) days, and the intraoperative blood loss was 50 (45, 100) ml. There were no significant differences in these variables between the two cohorts (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). These results showed that COPD did not cause prolonged operation or anesthesia time, increased intraoperative blood loss, extended the length of hospital stay or postoperative hospital stay in CRC patients with COPD. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of surgical and postoperative outcomes between the two cohorts\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOPD cohort\u003c/p\u003e \u003cp\u003e(\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-COPD cohort (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative duration(h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.17 (2.80, 5.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.42(3.15, 5.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.256\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnaesthetics duration(h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.67 (4.31, 6.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.50(4.58, 6.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal length of hospital stay(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22(17, 28.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(16.75, 25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of postoperative hospital stay(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.5(9, 16.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(8, 14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood loss(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50(30, 112.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(45, 100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.960\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe time of postoperative abdominal drainage tube removal(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(6, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(4.75, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe time of postoperative urinary catheter removal(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.5(4, 11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(3, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe time of first postoperative defecation(d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.5(4.75, 9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(2.75, 6.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICU admission stay (d)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(30.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(76.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(28.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(12.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026thinsp;~\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(21.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(19.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotic use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst and second generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27(48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(67.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbapenems, third generation cephalosporins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29(51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(19.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(16.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eglucocorticoid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esecondary operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-invasive assisted ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(19.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInvasive assisted ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(30.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(7.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFiberoptic bronchoscopy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntravenous pressor/vasoconstrictor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncision dehiscence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(30.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(8.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(14.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatheter-related infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeptic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(10.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypovolemic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(7.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eintestinal obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(7.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic hemorrhage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(5.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute kidney injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(3.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAfter CRC resection, in COPD cohort, the time of abdominal drainage tube removal was 8 (6,10) days, the time of urinary catheter removal was 5.5 (4,11) days and the time of first defecation was 6.5 (4.75,9) days. In the paired non-COPD cohort, the time of abdominal drainage tube removal was 7 (4.75, 9) days, the time of urinary catheter removal was 4 (3, 7) days, and the time of first defecation was 4 (2.75, 6.25) days. The results demonstrated that the time of postoperative urinary catheter removal and the time of first defecation after surgery in CRC patients with COPD were longer than that in CRC patients without COPD (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there was no statistical differences in the time of postoperative abdominal drainage tube removal between the two cohorts. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFurthermore, ICU admission rate after surgery was 69.64% in COPD cohort, whereas ICU admission rate was only 23.21% in non-COPD cohort, with a statistically significant difference (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the COPD cohort, 11 patients (19.64%) stayed in ICU for 6 days or more, 12 patients (21.43%) stayed in ICU for 3 to 5 days, and 16 patients (28.57%) stayed in ICU for 1 to 2 days. In the non-COPD cohort, only 1 (1.79%) patient stayed in ICU for more than 6 days, 5 patients stayed in ICU for 3 to 5 days, and 7 patients stayed in ICU for 1 to 2 days. Moreover, non-invasive assisted ventilation rates were 19.64% and 0%, invasive assisted ventilation rates were 30.36% and 7.14%, and fiberoptic bronchoscopy rates were 10.71% and 0% in the COPD cohort and in the non-COPD cohort, respectiely. However, no statistical differences were observed in postoperative blood transfusion rate, glucocorticoid utilization rate, secondary operation rate, hemodialysis rate, and the utilization rate of intravenous pressor or vasoconstrictor between 2 cohorts (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the use of antibiotics, we found that the usage of postoperative high-grade antibiotics such as carbapenems and third-generation cephalosporin in COPD cohort was more more common than that in non-COPD cohort (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The results indicate that CRC patients with COPD need more intensive care, more assisted ventilation and high-grade antibiotics after surgery.\u003c/p\u003e \u003cp\u003eWe compared the postoperative complications between COPD cohort and non-COPD cohort and found that a greater proportion of patients developed pneumonia and septic shock after CRC resection in COPD cohort than non-COPD cohort. However, there were no statistically significant differences in the incidence of wound infection, incision dehiscence, abdominal infection, catheter associated infection, urinary tract infection, hypovolemic shock, respiratory failure, heart failure, intestinal obstruction, anastomotic leakage, anastomotic hemorrhage, and acute kidney injury after surgery between the two cohorts (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e3.3 Postoperative overall survival was worse in COPD cohort\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eTo accurately assess the impact of COPD on the prognosis of CRC patients after surgery, we conducted survival correlation analysis in the 112 CRC patients. Our results showed that postoperative overall survival of patients was worse in COPD cohort than that in non-COPD cohort (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). However, we found no obvious differences in DFS (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB) and CSS (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC) between COPD and non-COPD cohorts.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA) Overall postoperative survival curve of patients in COPD group and non-COPD group;B) Postoperative disease-free survival curve of patients in COPD group and non-COPD group; C) Postoperative cancer-specific survival curves of patients in COPD group and non-COPD group;\u003c/p\u003e \u003cp\u003eTo explore the effect of neoplastic and other prognostic outcomes on the prognosis of CRC patients, we defined other death causes as non-neoplastic causes, such as severe pneumonia, other comorbidity. A competition risk model was established to determine whether there was a difference in cancer-specific death risk of patients between COPD and non-COPD cohorts. The results confirmed that no distinct difference in the risk of cancer-related death between COPD and non-COPD cohorts after controlling for competing risks of non-neoplastic causes (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eCIF: Cumulative incidence function. Red : Cumulative incidence (curve) of non-tumor causes of death in COPD group; Blue: Cumulative incidence (curve) of non-tumor causes of death in non-COPD group; Black : Cumulative incidence (curve) of death from CRC in COPD group; Green : Cumulative incidence (curve) of death from CRC in non-COPD group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4 COPD was an independent factor for overall survival of CRC patients\u003c/h2\u003e \u003cp\u003eUnivariate COX regression analysis showed that COPD, TNM stages, N stage, M stage, nerve invasion, surgical approach, ASA grade, preoperative CEA level, preoperative CA199 level, preoperative CA724 level and postoperative adjuvant therapy were correlated with overall survival of CRC patients (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, age, sex, BMI, maximum tumor diameter, T-stage, tumor location, differentiated degree, histological type, surgical time, surgical year, diabetes, hypertension, coronary heart disease, bronchial asthma, smoking and alcohol consumption history, and neoadjuvant therapy were not associated with overall survival (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of overall survival in patients with CRC\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eHR\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.012\u0026ndash;3.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.990\u0026ndash;1.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.377\u0026ndash;1.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.794\u0026ndash;1.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum\u003c/p\u003e \u003cp\u003etumor\u003c/p\u003e \u003cp\u003ediameter(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.806\u0026ndash;2.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTNM tumor stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.165\u0026ndash;0.767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u0026ndash;0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0-I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.031\u0026ndash;0.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.101\u0026ndash;1.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.227\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.087\u0026ndash;4.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.652\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.965\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.506\u0026ndash;5.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.852\u0026ndash;8.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.854\u0026ndash;11.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.411\u0026ndash;1.686\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDifferentiated degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u0026thinsp;+\u0026thinsp;High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.465\u0026ndash;3.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.509-2.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistological type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTubular adenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMucinous adenocarcinoma\u0026thinsp;+\u0026thinsp;Signet-ring cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.387\u0026ndash;4.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntramucosal carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.361\u0026ndash;6.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNerve invasion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.241\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.151\u0026ndash;4.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular infiltration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.953\u0026ndash;3.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical approach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaparoscopic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.097\u0026ndash;3.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelevtive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.649\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.397\u0026ndash;6.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2014\u0026ndash;2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2020\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.735\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.819\u0026ndash;3.676\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA grade\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI-II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII-IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.109\u0026ndash;3.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.199\u0026ndash;1.587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.557\u0026ndash;1.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoronary heart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.852\u0026ndash;3.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBronchial asthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.235\u0026ndash;2.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.549\u0026ndash;1.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.234\u0026ndash;1.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operative CEA level(ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.098\u0026ndash;3.915\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operative CA199 level(U/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.300-5.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operative CA724 level(U/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.120\u0026ndash;4.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeoadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.128\u0026ndash;2.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003eadjuvant therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.195\u0026ndash;0.846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSince Pearson's correlation test suggested obvious collinearity between TNM stages and N stage (correlation coefficient\u0026thinsp;=\u0026thinsp;0.704, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and M stage (correlation coefficient\u0026thinsp;=\u0026thinsp;0.669, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), only TNM stages was included in the multivariate analysis.\u003c/p\u003e \u003cp\u003eMultivariate COX regression analysis showed that COPD (HR\u0026thinsp;=\u0026thinsp;3.232, 95%CI: 1.537\u0026ndash;6.795, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) and TNM stages (Stage III \u003cem\u003evs.\u003c/em\u003e stage IV, HR\u0026thinsp;=\u0026thinsp;0.261, 95%CI: 0.099\u0026ndash;0.687, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007; Stage II \u003cem\u003evs.\u003c/em\u003e Stage IV, HR\u0026thinsp;=\u0026thinsp;0.129, 95%CI: 0.046\u0026ndash;0.360, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Stage 0-I \u003cem\u003evs.\u003c/em\u003e stage IV, HR\u0026thinsp;=\u0026thinsp;0.104, 95%CI: 0.025\u0026ndash;0.430, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) were independent prognostic factors in CRC patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study, we found that COPD and TNM stages were independent risk factors for overall survival of postoperative CRC patients, which is similar to the previous studies[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, COPD was not associated with postoperative CSS or DFS in CRC patients. Furthermore, our results demonstrated that COPD was correlated with more postoperative complications.\u003c/p\u003e \u003cp\u003eSurgical resection is the only potentially curative modality for localized CRC. Laparoscopic CRC resection is generally considered a safe and feasible treatment modality for CRC patients, especially for elderly CRC patients [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. General anesthesia with endotracheal intubation is the mainstream anesthesia method for most laparoscopic CRC resection. During laparoscopic surgery, pneumoperitoneum is always established by aerating the abdominal cavity with carbon dioxide to provide sufficient surgical field of view. Pneumoperitoneum can lead to decreased lung volume, increased peak airflow pressure, and decreased lung compliance. Moreover, upward displacement of the diaphragm makes it easier for ventilator-perfusion mismatch with more severe intrapulmonary shunt [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Thus, CRC patients with COPD pose challenges for both surgery and anesthesia. We found that CRC patients with COPD were more prone to postoperative pneumonia, septic shock, and the use of high-grade antibiotics, non-invasive assisted ventilation, invasive assisted ventilation, ICU admission, fiberoptic bronchoscopy compared with CRC patients without COPD. Furthermore, we found distinct differences in ICU admission between COPD and non-COPD patients and markedly prolonged postoperative ICU stay days in CRC patients with COPD. The reason why COPD patients need more ICU care after surgery might be associated with their poor pulmonary function or poor physical tolerance or more postoperative complication. In addition, we found that COPD patients had longer postoperative time of catheter removal and bowel recovery. However, there was no striking difference in overall hospital stay or postoperative hospital stay between the two cohorts. These results suggests that surgical resection is recommended for CRC patients with COPD and that CRC patients with COPD need more intensive postoperative care.\u003c/p\u003e \u003cp\u003eIn this study, we found that COPD was an independent risk factor for OS of CRC patients, but COPD was not associated with postoperative CSS or DFS in CRC patients. The results indicate that COPD is a very important factor which influences overall survival and that COPD doesn\u0026rsquo;t accelerate cancer recurrence and metastasis in CRC patients. Therefore, surgical resection is recommended for selective CRC patients with COPD under the condition of more intensive postoperative care.\u003c/p\u003e \u003cp\u003eTaken together, our results demonstrated that COPD was an independent risk factor for the overall survival of CRC patients and was correlated with more postoperative complications. However, COPD was not associated with postoperative CSS or DFS of CRC patients. The results suggest surgical resection is recommended for selective CRC patients with COPD under the condition of more intensive postoperative care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of interest\u003c/h2\u003e \u003cp\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors took part in designing the study, selection criteria, discussion, paper writing, and final approval of the article. JQ Wang, XE Zhang, GM Chen,YX Wu, X Yang and ZR Li contributed to data collection, statistical analyses, and table/figures manufacture. JX Chen contributed to double checking of included studies, quality assessment, and bias assessment. XE Zhang and JS Chen contributed to the paper revision. JS Chen finished the final checking of all content in this paper.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e \u003cp\u003eThis work was supported by grants from the National Natural Science Foundation of China (82072620), GuangDong Basic and Applied Basic Research Foundation (2021A1515011357) and Guangzhou Municipal Science and Technology Project (202102010158).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSUNG H, FERLAY J, SIEGEL R L, LAVERSANNE M, SOERJOMATARAM I, JEMAL A, BRAY F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 2021, 71(3): 209\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCancer stat facts: colorectal cancer. National Cancer Institute. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://seer.cancer.gov/statfacts/html/colorect.html\u003c/span\u003e\u003cspan address=\"https://seer.cancer.gov/statfacts/html/colorect.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed March 20, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWIDDISON A L, BARNETT S W, BETAMBEAU N. The impact of age on outcome after surgery for colorectal adenocarcinoma. Ann R Coll Surg Engl, 2011, 93(6): 445\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlobal Strategy for the Diagnosis, Management and Prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023.Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://goldcopd.org/2023-gold-report-2/\u003c/span\u003e\u003cspan address=\"https://goldcopd.org/2023-gold-report-2/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed March 20, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRUTTEN E P A, LENAERTS K, BUURMAN W A, WOUTERS E F M. Disturbed intestinal integrity in patients with COPD: effects of activities of daily living. Chest, 2014, 145(2): 245\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRUTTEN E P, SPRUIT M A, FRANSSEN F M, BUURMAN W A, WOUTERS E F, LENAERTS K. GI symptoms in patients with COPD. Chest, 2014, 145(6): 1437\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLEE J, IM J P, HAN K, PARK S, SOH H, CHOI K, KIM J, CHUN J, KIM J S. Risk of inflammatory bowel disease in patients with chronic obstructive pulmonary disease: A nationwide, population-based study. World J Gastroenterol, 2019, 25(42): 6354\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNIELSEN H M, RODSGAARD P A, WEINREICH U M. Chronic obstructive pulmonary disease as comorbidity in patients admitted to a university hospital: a cross-sectional study. Clin Respir J, 2014, 8(3): 274\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHUN E M, KIM S W, LIM S Y. Prevalence of colorectal adenomatous polyps in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2015, 10: 955\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhn, S. V., et al. (2020). Cancer development in patients with COPD: a retrospective analysis of the National Health Insurance Service-National Sample Cohort in Korea. BMC Pulm Med 2020, 20(1): 170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCOLGAN S P, TAYLOR C T. Hypoxia: an alarm signal during intestinal inflammation. Nat Rev Gastroenterol Hepatol, 2010, 7(5): 281\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXIN X, DAI W, WU J, FANG L, ZHAO M, ZHANG P, CHEN M. Mechanism of intestinal mucosal barrier dysfunction in a rat model of chronic obstructive pulmonary disease: An observational study. Exp Ther Med, 2016, 12(3): 1331\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKARADAG F, KIRDAR S, KARUL A B, CEYLAN E. The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Intern Med, 2008, 19(2): 104\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSPROOTEN R T M, LENAERTS K, BRAEKEN D C W, GRIMBERGEN I, RUTTEN E P, WOUTERS E F M, ROHDE G G U. Increased Small Intestinal Permeability during Severe Acute Exacerbations of COPD. Respiration, 2018, 95(5): 334\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN J, YIN Y, ZHANG Y, LIN X, CHEN T, YANG Z, WANG D, ZHONG W. Chronic Obstructive Pulmonary Disease Prevalence and Associated Risk Factors in Adults Aged 40 Years and Older in Southeast China: A Cross-Sectional Study During 2019\u0026ndash;2020. Int J Chron Obstruct Pulmon Dis, 2022, 17: 2317\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFIELDS A C, DIVINO C M. Surgical outcomes in patients with chronic obstructive pulmonary disease undergoing abdominal operations: An analysis of 331,425 patients. Surgery, 2016, 159(4): 1210\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBARE M, MONTON C, MORA L, REDONDO M, PONT M, ESCOBAR A, SARASQUETA C, FERNANDEZ DE LARREA N, BRIONES E, QUINTANA J M. COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1233\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHENG W J, CHIANG C C, PENG M T, HUANG Y T, HUANG J L, CHANG S H, YANG H T, CHEN W C, KUO J J, HWANG T L. Chronic Obstructive Pulmonary Disease Increases the Risk of Mortality among Patients with Colorectal Cancer: A Nationwide Population-Based Retrospective Cohort Study. Int J Environ Res Public Health, 2021, 18(16).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePLATON A M, ERICHSEN R, CHRISTIANSEN C F, ANDERSEN L K, SVAERKE C, MONTOMOLI J, SORENSEN H T. The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery: a Danish population-based cohort study. BMJ Open Respir Res, 2014, 1(1): e000036.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLEMMENS V E, JANSSEN-HEIJNEN M L, HOUTERMAN S, VERHEIJ K D, MARTIJN H, VAN DE POLL-FRANSE L, COEBERGH J W. Which comorbid conditions predict complications after surgery for colorectal cancer? World J Surg, 2007, 31(1): 192\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGUPTA H, RAMANAN B, GUPTA P K, FANG X, POLICH A, MODRYKAMIEN A, SCHULLER D, MORROW L E. Impact of COPD on postoperative outcomes: results from a national database. Chest, 2013, 143(6): 1599\u0026ndash;606.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN Y C, LI M C, YU Y H, LIN C M, WU S Y. Chronic Obstructive Pulmonary Disease and Its Acute Exacerbation before Colon Adenocarcinoma Treatment Are Associated with Higher Mortality: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study. Cancers (Basel), 2021, 13(18).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG J, CHIU K C, LIN W C, WU S Y. Survival Impact of Chronic Obstructive Pulmonary Disease or Acute Exacerbation on Patients with Rectal Adenocarcinoma Undergoing Curative Resection: A Propensity Score-Matched, Nationwide, Population-Based Cohort Study. Cancers (Basel), 2021, 13(16).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDEVOTO L, CELENTANO V, COHEN R, KHAN J, CHAND M. Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. Int J Colorectal Dis, 2017, 32(9): 1237\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNISHIKAWA T, KAWAI K, EMOTO S, MURONO K, HIYOSHI M, KANEKO M, SONODA H, SASAKI K, SHUNO Y, TANAKA T, HATA K, NOZAWA H. The influence of pulmonary comorbidities on treatment choice and short-term surgical outcomes among elderly patients with colorectal cancer. Int J Colorectal Dis, 2019, 34(8): 1497\u0026ndash;501.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePETERSSON J, MATTHIESSEN P, JADID K D, BOCK D, ANGENETE E. Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open. Sci Rep, 2023, 13(1): 4335.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKHETARPAL R, BALI K, CHATRATH V, BANSAL D. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries. Anesth Essays Res, 2016, 10(1): 7\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGRABOWSKI J E, TALAMINI M A. Physiological effects of pneumoperitoneum. J Gastrointest Surg, 2009, 13(5): 1009\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Colorectal cancer (CRC), Chronic obstructive pulmonary disease (COPD), Surgery, Complications, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-4590558/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4590558/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe impact of chronic obstructive pulmonary disease (COPD) on perioperative complications and prognosis in patients with colorectal cancer (CRC) is explored.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFifty-eight CRC patients with COPD and 671 CRC patients without COPD who underwent surgery for CRC in our hospital were retrospectively analyzed. Sociodemographic and clinical variables including tumor status, operative and anesthesia duration, length of hospital stay, the time of postoperative catheter removal and first defecation were compared between the two cohorts. Furthermore, postoperative intensive care unit (ICU) admission, use of mechanical ventilation, fiberoptic bronchoscopy rates, postoperative antibiotic treatment, presence of complications and cancer-specific survival (CSS) or disease-free survival (DFS) were analyzed. Finally, COX regression analysis was used to identify independent risk factors for overall survival (OS) in CRC patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCOPD and Tumor-Node-Metastasis (TNM) stages were independent risk factors for the postoperative OS in patients undergoing surgery for CRC. Moreover, time of postoperative urinary catheter removal and first defecation, ICU admission, use of mechanical ventilation, and fiberoptic bronchoscopy rates were significantly higher in CRC patients with COPD than in those without COPD. Furthermore, postoperative pneumonia and septic shock were more common in patients with COPD. However, COPD was not associated with CSS or DFS in CRC patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCOPD is an independent risk factor for OS in CRC patients after surgery, and is correlated with more postoperative complications, but it is not associated with CSS or DFS. Thus, surgical resection is recommended for selective CRC patients with COPD under the condition of more intensive postoperative care.\u003c/p\u003e","manuscriptTitle":"Impact of Chronic Obstructive Pulmonary Disease on surgical outcomes of Patients with Colorectal cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 16:41:42","doi":"10.21203/rs.3.rs-4590558/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b8ab1ca5-cfdc-4cca-bfa0-bd8ffd881e99","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-18T11:53:30+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 16:41:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4590558","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4590558","identity":"rs-4590558","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}