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Background This study investigated the incidence, risk factors, and prognostic significance of a high Comprehensive Complication Index (CCI, ≥26.2) in patients with left-sided colorectal cancer (CRC) undergoing para-aortic lymph node (PALN) dissection.Methods We retrospectively reviewed 190 patients with left-sided CRC who underwent PALN dissection at a high-volume center between May 2011 and July 2024. Patients were classified into high-CCI (≥26.2, n = 30) and low-CCI (<26.2, n = 160) groups. Clinicopathological characteristics, postoperative outcomes, long-term survival, and predictors of high CCI were analyzed. An intraoperative view and resected PALN specimen are shown in IDDF2026-ABS-0119 Figure 1(A,B). Temporal changes in surgical approach and the proportion of high CCI are presented in IDDF2026-ABS-0119 Figure 2(A). A nomogram was developed to predict the risk of high CCI (IDDF2026-ABS-0119 Figure 4(A-D)).Results Postoperative complications occurred in 45.3% of patients, with chylous fistula being the most frequent complication (21.6%). Compared with the low-CCI group, patients with high CCI had a lower prognostic nutritional index, a higher proportion of sigmoid/rectal tumors, fewer laparoscopic procedures, longer operative time, greater blood loss, and more advanced T stage (all P < 0.05). The high-CCI group had significantly worse 5-year overall survival than the low-CCI group (38.4% vs. 79.2%, P < 0.001), whereas disease-free survival did not differ significantly (P = 0.422) (IDDF2026-ABS-0119 Figure 2(B,C)). Multivariable analysis identified ASA grade III/IV, tumor location, operative time >214 min, and estimated blood loss >150 mL as independent predictors of high CCI (IDDF2026-ABS-0119 Figure 3). The nomogram demonstrated acceptable discrimination and calibration, with an AUC of 0.777, and showed potential clinical utility (IDDF2026-ABS-0119 Figure 4(B-D)).Conclusions High CCI was associated with adverse perioperative and long-term outcomes after PALN dissection for left-sided CRC. Several perioperative factors independently predicted high CCI. The proposed nomogram may facilitate preoperative risk stratification and perioperative decision-making.Abstract IDDF2026-ABS-0119 Figure 1Abstract IDDF2026-ABS-0119 Figure 2Abstract IDDF2026-ABS-0119 Figure 3Abstract IDDF2026-ABS-0119 Figure 4