Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Department of Surgery, Ureshino Medical Center, Saga, Japan.
Asian J Endosc Surg. 2023 Oct;16(4):706-714. doi: 10.1111/ases.13227. Epub 2023 Jul 6.
INSTRUCTION: In colon cancer, the incidence of postoperative ileus is reportedly higher for the right-side than for the left-side colon, but those studies included small numbers of subjects and contained several biases. Furthermore, risk factors for postoperative ileus remain unclear. METHODS: This multicenter study reviewed 1986 patients who underwent laparoscopic colectomy between 2016 and 2021 for right-side (n = 907) and left-side (n = 1079) colon cancer. After propensity score matching, 803 patients in each group were matched. RESULTS: Postoperative ileus occurred in 97 patients. Before matching, the proportion of female patients and median age were higher and frequency of preoperative stent insertion was lower with right colectomy (P < .001 each). After matching, the number of retrieved lymph nodes (17 vs 15, P < .001) and greater rates of undifferentiated adenocarcinoma (10.6% vs 5.1%, P < .001) and postoperative ileus (6.4% vs 3.2%, P = .004) were higher in right colectomy. Multivariate analysis revealed male gender (hazard ratio, 1.798; 95% confidence interval, 1.049-3.082; P = .32) and history of abdominal surgery (hazard ratio, 1.909; 95% confidence interval, 1.073-3.395; P = .027) as independent predictors of postoperative ileus in right-side colon cancer. CONCLUSION: This study revealed a higher risk of postoperative ileus after right colectomy with laparoscopic surgery. Male gender and history of abdominal surgery were risk factors for postoperative ileus after right colectomy.
方法:这项多中心研究回顾了 2016 年至 2021 年间接受腹腔镜结肠切除术的 1986 例右侧(n=907)和左侧(n=1079)结肠癌患者。在倾向评分匹配后,每组匹配了 803 例患者。
结果:发生术后肠梗阻的患者有 97 例。在匹配前,右半结肠切除术的女性患者比例和中位年龄较高,术前支架置入的频率较低(P<.001)。匹配后,右半结肠切除术的淋巴结检出数量(17 枚 vs 15 枚,P<.001)、未分化腺癌的比例(10.6% vs 5.1%,P<.001)和术后肠梗阻的发生率(6.4% vs 3.2%,P=.004)更高。多因素分析显示,男性(风险比,1.798;95%置信区间,1.049-3.082;P=.32)和腹部手术史(风险比,1.909;95%置信区间,1.073-3.395;P=.027)是右侧结肠癌术后肠梗阻的独立预测因素。
结论:本研究显示腹腔镜右半结肠切除术后发生术后肠梗阻的风险较高。男性和腹部手术史是右半结肠切除术后发生术后肠梗阻的危险因素。