Department of Digestive and Hepato-Pancreato-Biliary Surgery, Assistance Publique - Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Pierre and Marie Curie University, Paris, France; University Institute of Cancerology (Paris VI), Pierre & Marie Curie University, Paris, France.
Colorectal Dis. 2013 Sep;15(9):1078-85. doi: 10.1111/codi.12237.
We report on our experience of elective subtotal colectomy and ileosigmoid anastomosis for colon cancer with focus on postoperative results, function and quality of life.
Between 1998 and 2011, 106 consecutive patients with colonic malignancy underwent this procedure electively. Function and quality of life (EORTC QLQ-C30) were evaluated retrospectively with questionnaires sent to all patients free of recurrence.
There were 62 men and 44 women (mean age 63 years). Postoperative mortality and morbidity rates were 1.9 and 26.4%, respectively. Persistent ileus was the main early complication (16%). After a mean follow-up of 67 ± 36 months, 50 (78.1) out of 64 patients have been evaluated for function and quality of life. The mean number of bowel movements per 24 h was 3 ± 2 and significantly lower when the length of the remaining sigmoid colon was more than 15 cm (P = 0.049). Compared with a European reference population for EORTC QLQ-C30 results, our patients had significantly more diarrhoea (26 vs 3, P = 0.0002) but less pain (10 vs 25, P < 0.0001) and better global quality of life (77 vs 62, P < 0.0001).
Elective subtotal colectomy for colon cancer is safe and associated with good function and quality of life. Ileosigmoid anastomosis should be discussed when extended colectomy is required, providing the rectosigmoid junction and its vascular supply can be oncologically preserved. For tumours located in the transverse colon or at the splenic flexure, this procedure may be the best surgical option.
我们报告了我们在结肠癌选择性次全结肠切除和回肠-乙状结肠吻合术方面的经验，重点是术后结果、功能和生活质量。
1998 年至 2011 年间，106 例结肠恶性肿瘤患者接受了这种选择性手术。通过向所有无复发的患者发送问卷，回顾性评估功能和生活质量（EORTC QLQ-C30）。
男性 62 例，女性 44 例（平均年龄 63 岁）。术后死亡率和发病率分别为 1.9%和 26.4%。持续性肠梗阻是主要的早期并发症（16%）。平均随访 67 ± 36 个月后，64 例患者中有 50 例（78.1%）评估了功能和生活质量。24 小时内排便次数平均为 3 ± 2 次，当剩余乙状结肠长度超过 15 cm 时明显减少（P = 0.049）。与 EORTC QLQ-C30 结果的欧洲参考人群相比，我们的患者腹泻明显更多（26 比 3，P = 0.0002），但疼痛更少（10 比 25，P < 0.0001），整体生活质量更好（77 比 62，P < 0.0001）。
结肠癌选择性次全结肠切除术是安全的，并与良好的功能和生活质量相关。当需要广泛结肠切除术时，应讨论回肠-乙状结肠吻合术，前提是可以在肿瘤学上保留直肠乙状结肠交界处及其血管供应。对于位于横结肠或脾曲的肿瘤，该手术可能是最佳的手术选择。
