Comparison of recovery and outcome after left and right colectomy

Abstract

Aim The present study aimed to compare functional recovery and surgical outcomes after left and right colectomies. Method Consecutive elective left and right colon resections for benign and malignant indications, performed between 2011 and 2016 and recorded in a prospectively maintained enhanced recovery database, were analysed. Demographic and surgical items, as well as functional recovery and 30‐day complications, were compared between left‐sided and right‐sided colectomies. Multivariable analysis was performed to identify risk factors for postoperative ileus (POI). Results In total, 1001 left and 1041 right colectomies were comparable regarding demographic factors; only body mass index (BMI) was higher in patients undergoing left‐sided resections (> 30 kg/m2: 33% vs 27%, P = 0.004). Malignancy (29% vs 67%, P < 0.001) and Crohn's disease (1% vs 31%, P < 0.001) were preponderant in right colectomies, whereas diverticular disease (68% vs 1%, P < 0.001) was the most common indication for left colectomy. Compliance with the enhanced recovery pathway (ERP) was comparable. While the minimally invasive approach was the preferred approach for both sides (61% vs 64%, P = 0.158), left colectomies took longer (180 ± 80 min vs 150 ± 70 min, P < 0.001), needed more perioperative fluids (3.1 ± 1.4 l vs 2.7 ± 1.5 l, P < 0.001) and resulted in greater postoperative weight gain (3.9 ± 6.5 kg vs 2.6 ± 6 kg, P = 0.025). Crohn's disease (OR = 2.64, 95% CI: 1.27–5.46) and fluid overload (OR = 2.02, 95% CI: 1.06–3.82) were independent risk factors for POI. Conclusion Despite equal ERP compliance, postoperative ileus was higher after right‐sided colectomies. This finding was associated with Crohn's disease and fluid overload.

Surgical Resection for Crohn’s and Cancer: A Comparison of Disease-Specific Risk Factors and Outcomes

“…Right colectomy for cancer is a standardized procedure carried out by most general surgeons [10]. Because of the preponderance of terminal ileal disease and a 10-year risk of surgical resection of almost 50%, many patients with CD eventually require ileocolonic resections [11, 12]. Because of the complexity of medical management requiring thorough surveillance and follow-up, patients with CD are treated in dedicated inflammatory bowel disease units [13].…”

“…The older cancer cohort, presenting with more age-related comorbidities, was prone to both medical complications and increased 30-day mortality. Functional recovery (mobilization and alimentation) was likely accelerated in the younger CD population, which may have further contributed to decreased medical complications [12]. While LOS was similar in both groups (70% discharged within 5 days), (risk-adjusted) readmissions were higher in patients with CD.…”

Crohn’s versus Cancer: Comparison of Functional and Surgical Outcomes after Right-Sided Resections

“…They concluded that the underlying pathology does not influence surgical outcomes, similar as the present study, which focused in particular on functional outcomes. However, recent studies revealed delayed GI function associated with colectomy for inflammatory bowel disease [24, 25]. Dai et al [24] suggested preoperative conditioning (normalization of albumin levels, steroid weaning) and early management of postoperative sepsis as efficient measures to reduce POI.…”

Prognostic Immune-Related Analysis Based on Differentially Expressed Genes in Left- and Right-Sided Colon Adenocarcinoma

“…Although the CRCs are mainly distinguished with embryonic origin, there are great significances existing between the LCCs and RCCs in various clinical aspects, such as metastasis tendency, survival and prognosis, chemotherapy drugs, immunotherapy, and sensitivity of molecularly targeted drugs, etc. (5)(6)(7). The difference in prognosis makes colon cancer sidedness a criterion for predicting prognosis of all clinical stages (8).…”