HYPOTHESIS: Independent risk factors for postoperative morbidity after colectomy are most likely linked to disease characteristics. DESIGN: Retrospective analysis. SETTING: Twenty-eight centers of the French Federation for Surgical Research. PATIENTS: In total, 1721 patients (1230 with colon cancer [CC] and 491 with diverticular disease [DD]) from a databank of 7 prospective, multisite, randomized trials on colorectal resection. INTERVENTION: Elective left colectomy via laparotomy. MAIN OUTCOME MEASURES: Preoperative and intraoperative risk factors for postoperative morbidity. RESULTS: Overall postoperative morbidity was higher in CC than in DD (32.4% vs 30.3%) but the difference was not statistically significant (P = .40). Two independent risk factors for morbidity in CC were antecedent heart failure (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.42-6.32) (P = .003) and bothersome intraluminal fecal matter (2.08; 1.42-3.06) (P = .001). Three independent risk factors for morbidity in DD were at least 10% weight loss (OR, 2.06; 95% CI, 1.25-3.40) (P = .004), body mass index (calculated as weight in kilograms divided by height in meters squared) exceeding 30 (2.05; 1.15-3.66) (P = .02), and left hemicolectomy (vs left segmental colectomy) (2.01; 1.19-3.40) (P = .009). CONCLUSIONS: Patients undergoing elective left colectomy for CC or for DD constitute 2 distinct populations with completely different risk factors for morbidity, which should be addressed differently. Improving colonic cleanliness (by antiseptic enema) may reduce morbidity in CC. In DD, morbidity may be reduced by appropriate preoperative nutritive support (by immunonutrition), even in patients with obesity, and by preference of left segmental colectomy over left hemicolectomy. By decreasing morbidity, mortality should be lowered as well, especially when reoperation becomes necessary.
HYPOTHESIS: Independent risk factors for postoperative morbidity after colectomy are most likely linked to disease characteristics. DESIGN: Retrospective analysis. SETTING: Twenty-eight centers of the French Federation for Surgical Research. PATIENTS: In total, 1721 patients (1230 with colon cancer [CC] and 491 with diverticular disease [DD]) from a databank of 7 prospective, multisite, randomized trials on colorectal resection. INTERVENTION: Elective left colectomy via laparotomy. MAIN OUTCOME MEASURES: Preoperative and intraoperative risk factors for postoperative morbidity. RESULTS: Overall postoperative morbidity was higher in CC than in DD (32.4% vs 30.3%) but the difference was not statistically significant (P = .40). Two independent risk factors for morbidity in CC were antecedent heart failure (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.42-6.32) (P = .003) and bothersome intraluminal fecal matter (2.08; 1.42-3.06) (P = .001). Three independent risk factors for morbidity in DD were at least 10% weight loss (OR, 2.06; 95% CI, 1.25-3.40) (P = .004), body mass index (calculated as weight in kilograms divided by height in meters squared) exceeding 30 (2.05; 1.15-3.66) (P = .02), and left hemicolectomy (vs left segmental colectomy) (2.01; 1.19-3.40) (P = .009). CONCLUSIONS:Patients undergoing elective left colectomy for CC or for DD constitute 2 distinct populations with completely different risk factors for morbidity, which should be addressed differently. Improving colonic cleanliness (by antiseptic enema) may reduce morbidity in CC. In DD, morbidity may be reduced by appropriate preoperative nutritive support (by immunonutrition), even in patients with obesity, and by preference of left segmental colectomy over left hemicolectomy. By decreasing morbidity, mortality should be lowered as well, especially when reoperation becomes necessary.
Authors: Pedro Moya; Elena Miranda; Leticia Soriano-Irigaray; Antonio Arroyo; Maria-Del-Mar Aguilar; Marta Bellón; Jose-Luis Muñoz; Fernando Candela; Rafael Calpena Journal: Surg Endosc Date: 2016-03-02 Impact factor: 4.584
Authors: Teppei Morikawa; Noriko Tanaka; Aya Kuchiba; Katsuhiko Nosho; Mai Yamauchi; Jason L Hornick; Richard S Swanson; Andrew T Chan; Jeffrey A Meyerhardt; Curtis Huttenhower; Deborah Schrag; Charles S Fuchs; Shuji Ogino Journal: Arch Surg Date: 2012-08