Laparoscopic Surgery Is Associated With Reduced Small Bowel Obstruction Risk After Colorectal Cancer Surgery: A Nationwide Cohort Study of 5458 Patients

ABSTRACT Introduction Postoperative small bowel obstruction (SBO) is a major complication following colorectal cancer surgery, yet evidence‐based prevention strategies remain unclear. We aimed to clarify site‐specific risk factors for SBO and evaluate the effectiveness of laparoscopic surgery and adhesion prevention materials (APMs) in preventing SBO after colorectal cancer surgery. Methods This retrospective cohort study analyzed 5458 patients who underwent colorectal cancer surgery at 32 Japanese institutions between 2012 and 2014. The primary endpoint was the 5‐year risk of SBO. We evaluated the effects of laparoscopic surgery, APM use, and stoma creation on SBO risk. Clinical variables included demographics, tumor site, operative approach, operative details, and postoperative complications. Hospital‐level clustering was addressed using mixed‐effects logistic regression. Results Overall SBO incidence was 5.2% ( n = 283). Rectal cancer had the highest risk, whereas all colonic sites except the descending colon showed significantly lower odds. Laparoscopic surgery was associated with a 42% reduction in odds (OR 0.58; 95% CI 0.45–0.74; p < 0.001), with significant reductions in ascending (NNT = 22.2, p = 0.001) and sigmoid colon surgery (NNT = 30.2, p = 0.003). APMs showed no protective effect (OR 1.01; 95% CI 0.78–1.32; p = 0.94). Stoma creation significantly increased SBO risk (OR 1.84; 95% CI 1.35–2.51; p < 0.001). Secondary analysis identified reoperation and postoperative ileus as additional independent risk factors. Discussion Laparoscopic surgery was associated with reduced long‐term SBO risk, with significant benefits in ascending and sigmoid colon surgery. APMs showed no measurable benefit. Stoma creation increased SBO risk, with no observed difference between ileostomy and colostomy.