Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2020; 26(33): 4972-4982
Published online Sep 7, 2020. doi: 10.3748/wjg.v26.i33.4972
Bowel function and quality of life after minimally invasive colectomy with D3 lymphadenectomy for right-sided colon adenocarcinoma
Ki-Myung Lee, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim
Ki-Myung Lee, Se-Jin Baek, Jung-Myun Kwak, Jin Kim, Seon-Hahn Kim, Department of Surgery, Korea University College of Medicine, Seoul 02841, South Korea
Author contributions: Lee KM wrote this manuscript; Kwak JM, Kim J, and Kim SH reviewed the paper; Baek SJ mainly provided the main conceptualization.
Institutional review board statement: This study was approved by the Institutional Review Board (IRB) of Korea University ANAM Hospital, IRB No. 2020AN0004.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: There are no conflicts of interest to declare. This study was previously presented as a poster at the 2019 Annual Scientific Meeting of the American Society of Colon & Rectal Surgeons (ASCRS), June 1–5, 2019, Cleveland, OH, United States.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Se-Jin Baek, MD, PhD, Doctor, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, South Korea. xezin@korea.ac.kr
Received: March 27, 2020
Peer-review started: March 27, 2020
First decision: May 21, 2020
Revised: May 29, 2020
Accepted: June 17, 2020
Article in press: June 17, 2020
Published online: September 7, 2020
Abstract
BACKGROUND

Changes in bowel function after right-sided colectomy are not well understood compared to those associated with left-sided colectomy or rectal resection. In particular, there are concerns about bowel function after right-sided colectomy with complete mesocolic excision, which has become popular in the West.

AIM

To evaluate the functional outcomes of patients who underwent right-sided colectomy with D3 lymphadenectomy for colon cancer.

METHODS

Functional data from patients who underwent minimally invasive right-sided colectomy for colon cancer from October 2017 to September 2018 were prospectively collected. Functional outcomes were evaluated preoperatively and at 3, 6, 12, and 18 mo postoperatively.

RESULTS

Prior to surgery, 57 patients answered the questionnaire, and 47 responded at three months, 52 at 6 mo, 52 at 12 mo, and 25 at 18 mo postoperatively. Most scales of quality of life and bowel function improved significantly over time. Urgency persisted to a high degree throughout the period without a significant change over time. The use of medications for defecation was about 10% over the entire period. Gas (P = 0.023) and fecal frequency (P < 0.001) increased, and bowel dysfunction group (P = 0.028) was more common among patients taking medication. At six months, resected bowel and colon lengths were significantly different as a risk factor between the dysfunction group and the no dysfunction group [odd ratio (OR): 1.095, P = 0.026; OR: 1.147, P = 0.031, respectively] in univariate analysis, but not in multivariate analysis.

CONCLUSION

Despite D3 lymphadenectomy, most bowel symptoms improved over time after right-sided colectomy using a minimally invasive approach, and continuous medication was needed in only approximately 10% of patients.

Keywords: Colonic neoplasm, Right colectomy, Bowel function, D3 lymphadenectomy, Complete mesocolic excision, Quality of life

Core tip: In patients who underwent right-sided colectomy, bowel function and quality of life are mostly well preserved. Although concerns about functional outcomes have been raised since complete mesocolic excision has been widely applied, no significant problems have been experienced by patients. Approximately 10% of patients continue to need medication, and we need to pay attention to these patients.