Yngve Thorsen1,2, Bojan V Stimec3, Jonas Christoffer Lindstrom1,4, Tom Oresland1,2, Dejan Ignjatovic1,2. 1. Department of Clinical Medicine, University of Oslo, Oslo, Norway. 2. Department of Gastroenterological Surgery, Akershus University Hospital, Lorenskog, Norway. 3. Faculty of Medicine, Anatomy Sector, Teaching Unit, University of Geneva, Geneva, Switzerland. 4. Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway.
Abstract
INTRODUCTION: To improve oncological outcome in right colon cancer surgery, an extended mesenterectomy (D3) is under evaluation. In this procedure, all tissue anterior and posterior to the superior mesenteric vessels from the middle colic to ileocolic artery origin is removed, causing injury to the superior mesenteric nerve plexus. The aim was to study the effects of this injury on bowel dynamics and quality of life (QoL). METHODS: Patients undergoing right colectomy with conventional D2- and extended D3-mesenterectomy were asked to record stool number and consistency for 60 d after surgery and complete questionnaires regarding QoL and bowel function (BF) before and after recovery from surgery. We compared early postoperative stool dynamics and long-term QoL in the groups and presented graphs depicting the temporal profile of stool numbers and consistency. RESULTS: Thirty-three patients operated with a D3-resection and 12 patients with a D2-resection participated. The results revealed significantly higher stool numbers in the D3-group until day 26, with significantly more loose-watery stools until day 40. The most pronounced difference was found on day 9 (Mean difference in the total number of stools: 2.25 stools/day, p=.004. Mean difference in loose-watery stools/day: 2.81 p<.001). About 25% in the D2- and 69.7% in the D3-group reported having more than three stools/day in the early postoperative phase. There were no differences in long-term QoL and BF between the groups except in stool consistency (p=.039). DISCUSSION/ CONCLUSIONS: Denervation following extended D3-mesenterectomy leads to transitory reduced consistency and increased frequency. It does not affect long-term QoL or BF.
INTRODUCTION: To improve oncological outcome in right colon cancer surgery, an extended mesenterectomy (D3) is under evaluation. In this procedure, all tissue anterior and posterior to the superior mesenteric vessels from the middle colic to ileocolic artery origin is removed, causing injury to the superior mesenteric nerve plexus. The aim was to study the effects of this injury on bowel dynamics and quality of life (QoL). METHODS: Patients undergoing right colectomy with conventional D2- and extended D3-mesenterectomy were asked to record stool number and consistency for 60 d after surgery and complete questionnaires regarding QoL and bowel function (BF) before and after recovery from surgery. We compared early postoperative stool dynamics and long-term QoL in the groups and presented graphs depicting the temporal profile of stool numbers and consistency. RESULTS: Thirty-three patients operated with a D3-resection and 12 patients with a D2-resection participated. The results revealed significantly higher stool numbers in the D3-group until day 26, with significantly more loose-watery stools until day 40. The most pronounced difference was found on day 9 (Mean difference in the total number of stools: 2.25 stools/day, p=.004. Mean difference in loose-watery stools/day: 2.81 p<.001). About 25% in the D2- and 69.7% in the D3-group reported having more than three stools/day in the early postoperative phase. There were no differences in long-term QoL and BF between the groups except in stool consistency (p=.039). DISCUSSION/ CONCLUSIONS: Denervation following extended D3-mesenterectomy leads to transitory reduced consistency and increased frequency. It does not affect long-term QoL or BF.
Entities:
Keywords:
Colorectal surgery; D3-mesenterectomy; colorectal cancer; extrinsic denervation of the small bowel; extrinsic nerves; postoperative bowel function; postoperative diary; quality of life; right colectomy; superior mesenteric plexus
Authors: Javier A Luzon; Yngve Thorsen; Liebert P Nogueira; Solveig N Andersen; Bjørn Edwin; Håvard J Haugen; Dejan Ignjatovic; Bojan V Stimec Journal: Surg Endosc Date: 2022-04-05 Impact factor: 3.453