Department of Visceral Surgery, University Hospital of Lugano (EOC), Via Tesserete 46, 6900, Lugano, Switzerland.
Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 21, 1011, Lausanne, Switzerland.
Langenbecks Arch Surg. 2021 Aug;406(5):1563-1570. doi: 10.1007/s00423-021-02082-3. Epub 2021 Jan 17.
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.
背景:已知右结肠切除术(RC)后肠道功能恢复比左结肠切除术(LC)慢,但关于横结肠切除术(TC)的报道很少。
目的:本研究旨在比较 TC 与 RC 和 LC 治疗结直肠癌的临床和早期功能结果。
方法:在 2011 年 12 月至 2017 年 12 月期间,我们机构所有接受择期结肠切除术的患者均根据标准化 ERAS 方案进行治疗,并被纳入前瞻性数据库。我们纳入了接受腹腔镜 TC、RC 或 LC 治疗结直肠癌的患者。主要终点是术后长时间肠麻痹(PPOI),定义为需要插入鼻胃管,或术后第 3 天及以后的 VAS 恶心评分>4。次要终点是术后发病率和住院时间(LoS)。
结果:在 286 例患者中,有 126 例符合纳入标准:20 例行 TC,65 例行 RC,41 例行 LC。LC 组患者比 TC 和 RC 组年轻;其他基线人口统计学数据相似。PPOI 分别发生在 TC、RC 和 LC 组的 5(25%)、26(40%)和 10(24%)例患者中(p=0.417)。在单组比较中,与 RC 组相比,TC 组 PPOI 的发生率显著降低(RC 的 OR:4.255,95%CI 1.092-16.667,p=0.037),与 LC 组相似。在术后并发症或 LoS 方面没有观察到显著差异。
结论:在 ERAS 方案中,癌症的节段性腹腔镜结肠切除术术后 PPOI 的发生率在 TC 与 LC 一样低,且低于 RC。在 RC 后,可能需要考虑更缓慢的口服摄入,因为这是 PPOI 的独立预测因素。
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