Raffaello Roesel1, Francesco Mongelli2, Costanza Ajani2, Fabiano Iaquinandi2, Diana Celio2, Dimitri Christoforidis2,3. 1. Department of Visceral Surgery, University Hospital of Lugano (EOC), Via Tesserete 46, 6900, Lugano, Switzerland. raffaello.roesel@eoc.ch. 2. Department of Visceral Surgery, University Hospital of Lugano (EOC), Via Tesserete 46, 6900, Lugano, Switzerland. 3. Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
Abstract
BACKGROUND: It is known that functional recovery of the bowel is slower after right colectomy (RC) compared to left colectomy (LC), but very little has been reported on transverse colectomy (TC). OBJECTIVES: The aim of this study was to compare the clinical and early functional outcomes of TC, a more infrequent operation, to RC, and LC for colorectal cancer. METHODS: Between December 2011 and December 2017, all patients undergoing elective colon resection in our institution were treated according to a standardized ERAS protocol and entered in a prospective database. We included in the study patients undergoing laparoscopic TC, RC, or LC for cancer with curative intent. The primary endpoint was prolonged postoperative ileus (PPOI), defined as need to insert a nasogastric tube, or refractory nausea VAS > 4 on or after the third postoperative day. Secondary endpoints were postoperative morbidity and length of hospital stay (LoS). RESULTS: Out of 286 patients, 126 met the inclusion criteria: 20 underwent TC, 65 RC, and 41 LC. Patients in LC group were younger than in TC and RC groups; other baseline demographics were similar. PPOI was observed in 5 (25%), 26 (40%), and 10 (24%) patients in TC, RC, and LC groups, respectively (p = 0.417). In single group comparisons, the incidence of PPOI in the TC group was significantly lower in comparison to the RC group (OR for RC: 4.255, 95% CI 1.092-16.667, p = 0.037) and similar to the LC group. No significant differences in terms of postoperative complications or LoS stay were observed. CONCLUSION: The incidence of PPOI after segmental laparoscopic colectomy for cancer within an ERAS program appears as infrequent in TC as in LC and lower than after RC. It may be reasonable to consider a slower oral intake after RC, as it represents an independent predictor of PPOI.
BACKGROUND: It is known that functional recovery of the bowel is slower after right colectomy (RC) compared to left colectomy (LC), but very little has been reported on transverse colectomy (TC). OBJECTIVES: The aim of this study was to compare the clinical and early functional outcomes of TC, a more infrequent operation, to RC, and LC for colorectal cancer. METHODS: Between December 2011 and December 2017, all patients undergoing elective colon resection in our institution were treated according to a standardized ERAS protocol and entered in a prospective database. We included in the study patients undergoing laparoscopic TC, RC, or LC for cancer with curative intent. The primary endpoint was prolonged postoperative ileus (PPOI), defined as need to insert a nasogastric tube, or refractory nausea VAS > 4 on or after the third postoperative day. Secondary endpoints were postoperative morbidity and length of hospital stay (LoS). RESULTS: Out of 286 patients, 126 met the inclusion criteria: 20 underwent TC, 65 RC, and 41 LC. Patients in LC group were younger than in TC and RC groups; other baseline demographics were similar. PPOI was observed in 5 (25%), 26 (40%), and 10 (24%) patients in TC, RC, and LC groups, respectively (p = 0.417). In single group comparisons, the incidence of PPOI in the TC group was significantly lower in comparison to the RC group (OR for RC: 4.255, 95% CI 1.092-16.667, p = 0.037) and similar to the LC group. No significant differences in terms of postoperative complications or LoS stay were observed. CONCLUSION: The incidence of PPOI after segmental laparoscopic colectomy for cancer within an ERAS program appears as infrequent in TC as in LC and lower than after RC. It may be reasonable to consider a slower oral intake after RC, as it represents an independent predictor of PPOI.
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