Segmental vs. Extended Colectomy: Measurable Differences in Morbidity, Function, and Quality of Life

You, Y. Nancy; Chua, Heidi K; Nelson, Heidi D; Hassan, Iffat; Barnes, Sunni A.; Harrington, Jeffrey R.

doi:10.1007/s10350-008-9325-1

Cited by 133 publications

(97 citation statements)

References 28 publications

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“…c-d Intraoperative pictures show the cecum in the right hypochondrium just below the liver, while the hepatic flexure is anastomosed to the rectum The sparing of the right colon, ileocecal valve and terminal ileum has been shown to ensure normal stool consistency and a return of regular transit in contrast to total colectomy. You et al [1] reported a median daily stool frequency of 5 after ileorectal anastomosis, despite considerable dietary restrictions (55.6% of patients) and medication use (19.6% daily). In contrast, in the series by Kontovounisios et al [4], 71.4% of patients had two bowel movements per day following the Deloyers procedure, 21.4% had 3 per day, and 7.2% had 1 per day.…”

Section: Discussionmentioning

confidence: 98%

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Laparoscopic Deloyers procedure for tension-free anastomosis after extended left colectomy: technique and results

et al. 2016

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Section: Discussionmentioning

confidence: 98%

“…Following extended left colectomy, the residual colon may not reach the rectal stump without undue tension. A total colectomy and ileorectal anastomosis could be an alternative in these cases, although it may be associated with impaired bowel function and reduced quality of life compared to segmental resection [1,2].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Deloyers procedure for tension-free anastomosis after extended left colectomy: technique and results

et al. 2016

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“…Therefore, some guidelines and previous reports have recommended STC, rather than SGC, as the primary treatment for initial CRC in Lynch syndrome patients [3, 4, 10, 11]. On the other hand, previous reports demonstrated that bowel function was significantly worse in patients after STC than after SGC, but general quality of life (QOL) after surgery did not differ significantly between SGC and STC [12, 13]. Obviously, for decision-making regarding surgical strategies, it is important to consider the pros and cons of each surgical procedure, including the risk of metachronous CRC development, bowel function, and QOL after surgery, and life expectancy if differences exist.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Segmental Colectomy Followed by Endoscopic Surveillance as a Treatment Strategy for Colorectal Cancer Patients with Lynch Syndrome

et al. 2017

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Background: Initial surgical procedures for colorectal cancer (CRC) patients with Lynch syndrome remain controversial. This study assessed the validity of segmental colectomy (SGC) followed by endoscopic surveillance as a treatment strategy for CRC patients with Lynch syndrome. Methods: Among consecutive patients who underwent surgery for primary CRC between April 1985 and December 2014, 49 patients were observed to have germline mutations in a mismatch repair gene, and 38 patients who underwent SGC followed by periodic endoscopic surveillance at our institution were evaluated for metachronous CRC, need for secondary surgery, and the details of endoscopic surveillance. Results: Of the 38 patients who underwent SGC followed by periodic endoscopic surveillance at our institution, 6 (15.8%) patients showed metachronous CRC, 3 (7.9%) patients underwent endoscopic resection, and the other 3 patients (7.9%) underwent secondary surgery. The dispersion of the endoscopic surveillance interval was significantly greater in patients with metachronous CRC (364 ± 332.9 days) than in those without metachronous CRC (370 ± 129.7 days; p < 0.001). Conclusions: SGC followed by annual endoscopic surveillance was feasible as a treatment strategy for CRC patients with Lynch syndrome, because the incidence of metachronous CRC and the need for secondary surgery were low. Annual and periodic endoscopic surveillance might be essential for early detection of metachronous CRC and prevention of secondary surgery because of metachronous CRC in CRC patients with Lynch syndrome after SGC.

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“…In addition, patient and provider concerns regarding bowel function and quality of life after more extensive surgery may limit the performance of more extensive surgery even in the presence of abnormal testing. Those undergoing more extensive colonic resection may potentially experience increased stool frequency with a potential impact on quality of life [11]. However, this must be balanced with reduction in CRC risk that is achieved with more extensive surgery.…”

mentioning

confidence: 99%

Diagnosis of Lynch syndrome before colorectal resection: does it matter?

2016

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Lynch syndrome (LS), also known as hereditary nonpolyposis colorectal cancer (HNPCC), is an autosomal dominant genetic condition which predisposes patients to several different types of cancer, most notably colorectal cancer [1]. LS can be implicated in up to 5 % of colorectal cancers (CRC), making it the most common form of hereditary CRC [2]. However, in patients with early-onset CRC this number can be up to 17 % [3]. There has been an increased focus on early-onset CRC in general due to recently demonstrated rising CRC incidence rates in this group, although the underlying pathogenic factors are not completely understood [4]. Timing of LS diagnosis in suspected patients is critical, as early identification can facilitate management decisions regarding surgical intervention, colonoscopic surveillance and screening for extracolonic cancers. In addition, expedited germline genetic testing can be offered to at-risk family members.Recent guidelines suggest that all newly diagnosed CRCs, regardless of patient age, can be considered for evaluation for mismatch repair deficiency by microsatellite instability (MSI) and/or immunohistochemistry (IHC) testing for mismatch repair proteins [5]. Germline genetic testing can follow in order to confirm LS and assess for specific underlying mutations. When surgery is indicated, the aforementioned testing should ideally occur preoperatively so that results can assist planning and decision making in the operating room [5]. Due to high rates of metachronous CRC in LS patients undergoing partial colon resections (16 % at 10 years, 41 % at 20 years and 62 % at 30 years), even in those undergoing colonoscopic surveillance, colectomy with ileorectal anastomosis is recommended [5,6]. Studies have demonstrated the rate of metachronous lesions to drop significantly (postoperative risk is 0-3.4 %) when the recommended surgical intervention was performed [6,7]. Given this expanding appreciation for the role that genetic analysis may play in CRC surgical and medical management, the expectations would be for a rise in genetic evaluation, unfortunately the reality seems far from it.A recent study utilizing CDC comparative effectiveness research data conducted by our group evaluated the frequency of MSI and IHC testing in early-onset CRC patients and availability of testing results preoperatively [8]. The study, which was the first population-based study in the USA to evaluate LS screening practices, took place in Louisiana, which was recently demonstrated to have one of the highest incidence rates of CRC in the USA and very high rates of early-onset CRC, particularly in certain regions [9]. Data collected from the Louisiana Tumor Registry totaling 274 patients statewide B50 years of age and diagnosed with CRC in 2011 were analyzed. They found that in this young, high-risk population in which LS screening rates would be expected to be the highest, MSI and/or IHC testing was performed in only 23 % of patients with abnormalities found in 21.7 % of cases. Additionally, of those with abnormal IHC...

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Segmental vs. Extended Colectomy: Measurable Differences in Morbidity, Function, and Quality of Life

Abstract: Measurable compromises in long-term bowel function and quality of life were observed after extended vs. segmental resections. The relative differences in patient-related outcomes should be deliberated against the clinical benefits of extended resection for the individual patient.

Cited by 133 publications

References 28 publications

Laparoscopic Deloyers procedure for tension-free anastomosis after extended left colectomy: technique and results

Laparoscopic Deloyers procedure for tension-free anastomosis after extended left colectomy: technique and results

Feasibility of Segmental Colectomy Followed by Endoscopic Surveillance as a Treatment Strategy for Colorectal Cancer Patients with Lynch Syndrome

Diagnosis of Lynch syndrome before colorectal resection: does it matter?

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