Effects of Perioperative ¹⁷⁷ Lutetium-Labeled Targeted Radionuclide Therapy on Inflammatory Response and Intestinal Recovery in Colorectal Cancer

Objective: To investigate the effects of perioperative 177 Lutetium ( 177 Lu)-labeled anticarcinoembryonic antigen (CEA)-targeted radionuclide therapy (TRT) on perioperative inflammatory response, intestinal function recovery, pain control, dosimetric safety, and postoperative complications in colorectal cancer surgery patients within a precision oncology framework. Methods: A retrospective analysis of 72 patients who underwent elective radical colorectal cancer surgery (January 2022–December 2023). Patients were divided into a TRT group and a control group (36 cases each). The TRT group received 177 Lu-labetuzumab (1.85 GBq) 48 h preoperatively and a consolidation dose (0.74 GBq) at 24 h postoperatively; the control group received equivalent saline. Perioperative inflammatory markers [C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), white blood cell, neutrophil percentage], intestinal function recovery, visual analogue scale (VAS) pain scores, analgesic medication usage, dosimetric parameters, nutritional indicators, and postoperative complications were compared. Results: Baseline characteristics were comparable between groups ( p > 0.05). Compared with the control group, the TRT group showed significantly lower inflammatory markers on postoperative days 3 and 7 ( p < 0.05), shorter bowel sound recovery time (18.4 ± 6.7 h vs. 26.8 ± 8.9 h), first flatus time (28.6 ± 9.3 h vs. 42.1 ± 12.7 h), and defecation time (58.7 ± 18.4 h vs. 78.9 ± 22.6 h) ( p < 0.001). VAS scores at all time points were significantly lower ( p < 0.001), with reduced analgesic consumption. Tumor-absorbed dose was 32.7 ± 8.4 Gy with critical organ doses within International Commission on Radiological Protection tolerance. No serious radiotoxic adverse reactions occurred. Conclusions: In this retrospective exploratory study of imaging-selected colorectal cancer patients, perioperative 177 Lu-labeled anti-CEA TRT was associated with lower postoperative inflammatory marker levels, faster recovery of intestinal function, reduced analgesic requirements, and an acceptable short-term safety profile. These findings suggest that perioperative TRT may have potential short-term benefits in carefully selected patients, but prospective studies are required before broader clinical adoption.