Systematic review: the effect of right hemicolectomy for cancer on postoperative bowel function

Abstract

Background Right-sided cancer accounts for approximately 30% of bowel cancer in women and 22% in men. Colonic resection can cause changes in bowel function which affect daily activity. The aims are to assess the impact of right hemicolectomy for cancer on bowel function and to identify useful treatment modalities for managing bowel dysfunction after right hemicolectomy. Method The review was conducted in line with PRISMA. Eligible studies evaluated the impact of right hemicolectomy on bowel function in those treated for colorectal neoplasia or assessed the effect of surgical technique or other intervention on bowel function after right hemicolectomy. Right hemicolectomy for inflammatory bowel disease or benign cases only were excluded. Articles were limited to studies on human subjects written in English published between January 2008 and December 2018. Results The searches identified 7531 articles. Nine articles met the inclusion criteria, of which eight were cohort studies and one was a randomised trial. Loose stool, increased bowel frequency and/or nocturnal defaecation following right-sided colectomy occurs in approximately one in five patients. Some of these symptoms may improve spontaneously with time. Bile acid malabsorption and/or small bowel bacterial overgrowth may be the cause for chronic dysfunction. Some studies report that no or little difference in outcome between right-sided and rectal resections likely suggests poor function after right-sided resection. Conclusion Right hemicolectomy can result in changes to bowel function. Patients should be counselled preoperatively, and follow-up should be designed to identify and effectively treat significantly altered bowel function.

Functional Bowel Complaints and the Impact on Quality of Life After Colorectal Cancer Surgery in the Elderly

“…While colonic dysmotility seems to contribute to LARS after colon cancer surgery as well, the reduced absorptive capacity of electrolytes and water probably results in more liquid stool, increased bowel frequency and the risk for faecal incontinence ( 9 , 25 – 27 ). In accordance to the existing literature, the present study observed that LARS complaints were most prevalent in colon cancer patients after a sigmoid resection or right hemicolectomy ( 9 , 11 , 25 , 27 , 28 ). Most likely, the reduced reservoir capacity of the rectum when incorporated in an anastomosis is an additional factor contributing to these complaints after a sigmoid resection ( 10 ).…”

“…Most likely, the reduced reservoir capacity of the rectum when incorporated in an anastomosis is an additional factor contributing to these complaints after a sigmoid resection ( 10 ). While after a right hemicolectomy, the loss of the right colon, which is considered as the main site for water absorption, might contribute to the increased risk for complaints ( 25 , 28 ). Besides, the loss of the ileocaecal valve and its sphincter function, the consequent ileocolic dysmotility and the increased malabsorption of bile acids in the terminal ileum may also declare the increased bowel complaints observed after a right hemicolectomy ( 25 , 28 ).…”

“…While after a right hemicolectomy, the loss of the right colon, which is considered as the main site for water absorption, might contribute to the increased risk for complaints ( 25 , 28 ). Besides, the loss of the ileocaecal valve and its sphincter function, the consequent ileocolic dysmotility and the increased malabsorption of bile acids in the terminal ileum may also declare the increased bowel complaints observed after a right hemicolectomy ( 25 , 28 ). However, it should also be noted that among the general population without a history of abdominal surgery, 8-15% suffers from major LARS as well ( 7 , 29 ).…”

Long‐term gastrointestinal sequelae in colon cancer survivors: prospective pilot study on identification, the need for clinical evaluation and effects of treatment

“…While urgency is common among colon cancer survivors in general, patients who have undergone right‐sided resection suffer from increased defaecation frequency, loose stools and nocturnal defaecation. Patients who have undergone left‐sided resection often have fragmentation, a feeling of obstruction and require a long time for evacuation [4–7]. Importantly, most symptoms can be relieved if patients are treated properly [8].…”

Laparoscopic Right Hemicolectomy and Primary Anastomosis for Tubulovillous Polyp with Preoperative Endoscopic Tattooing as A Preventive Treatment in High Risk Colorectal Cancer Patient Case Report and Review

“…It is well established that colorectal cancer (CRC) develops from a series of precursor epithelial polyps [1], which include conventional adenomas, incorporating tubular adenomas and villous/tubulovillous adenomas (VA/TVA) and serrated polyps, incorporating hyperplastic polyps (HP), sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA). VA/TVAs are thought to be the advanced precursors in the "adenoma-carcinoma" pathway [2]. Risk factors include advancing age, male gender, highfat, low-fiber diet, tobacco use, and excess alcohol intake (more than eight drinks a week).…”