Mortality, morbidity and functional outcome after total or subtotal abdominal colectomy in the asian population

The Experience of Extended Bowel Resection in Individuals With a High Metachronous Colorectal Cancer Risk: A Qualitative Study

PURPOSE/OBJECTIVES

To ascertain individual experiences of extended bowel resection as treatment for colorectal cancer (CRC) in those with a high metachronous CRC risk, including the self-reported adequacy of information received at different time points of treatment and recovery.
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RESEARCH APPROACH

Qualitative.
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SETTING

Participants were recruited through the Australasian Colorectal Cancer Family Registry and two hospitals in Melbourne, Australia.
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PARTICIPANTS

18 individuals with a high metachronous CRC risk who had an extended bowel resection from 6-12 months ago.
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METHODOLOGIC APPROACH

Semistructured interviews. Data were analyzed thematically.
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FINDINGS

In most cases, the treating surgeon decided on the best option regarding surgical treatment. Participants felt well informed about the surgical procedure. Information related to surgical outcomes, recovery, and lifestyle adjustment from surgery was not always adequate. Many participants described ongoing worry about developing another cancer. 
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CONCLUSIONS

Patients undergoing an extended resection to reduce metachronous CRC risk require detailed information delivered at more than one time point and relating to several different aspects of the surgical procedure and its outcomes.
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INTERPRETATION

An increased emphasis should be given to the provision of patient information on surgical outcomes, recovery, and lifestyle adjustment. Colorectal nurses could provide support for some of the reported unmet needs.

Decision Model of Segmental Compared With Total Abdominal Colectomy for Colon Cancer in Hereditary Nonpolyposis Colorectal Cancer

Purpose

In choosing the appropriate surgical option for patients with colon cancer and Lynch syndrome, goals of treatment are to maximize life expectancy while preserving quality of life. This study constructs a decision model that encompasses these two related considerations.

Methods

We constructed a state-transition (Markov) model based on assumptions obtained from available data sources and published literature. Two strategies were considered for the treatment of colon cancer in a patient with Lynch syndrome: segmental colectomy (SEG) and total abdominal colectomy (TAC) with ileorectal anastomosis. Quality-adjusted life years (QALYs) were calculated based on utility states for patients based on the colectomy they received. Multiple sensitivity analyses were planned to examine the impact of each assumption on model results.

Results

For young (30-year-old) patients with Lynch syndrome, mean survival was slightly better with TAC than with SEG (34.8 v 35.5 years). When QALYs were considered, the two strategies were approximately equivalent, with QALYs per patient of 21.5 for SEG and 21.2 for TAC. With advancing age, SEG becomes a more favorable strategy. Results of our model were most sensitive to the utility state of TAC (relative to SEG), rates of metachronous occurrence, and stage of cancer at the time of such occurrence.

Conclusion

SEG and TAC are approximately equivalent strategies for patients with colon cancer and Lynch syndrome. The decision regarding which operation is preferable should be made on the basis of patient factors and preferences, with special emphasis on age and the ability of the patient to utilize intensive surveillance.

Emergency subtotal colectomy for lower gastrointestinal haemorrhage: over-utilised or under-estimated?

INTRODUCTION

A minority of patients with unlocalised massive lower gastrointestinal bleeding (LGIB) will require treatment with emergency subtotal colectomy (STC).

METHODS

To determine the outcome of STC in this high-risk group, we retrospectively reviewed the histopathology reports and case records of all subtotal colectomies performed for LGIB over a 8-year period.

RESULTS

Fifty-eight patients (mean age: 71 years; male to female ratio, 1 : 1) underwent emergency surgery for unlocalised LGIB, 45% of which were massive on admission, and unresponsive to resuscitation. The remainder had persistent or recurrent bleeding during the index hospitalisation. The hospitalisation for colectomy represented the first for LGIB for 56% of the study group, while 38% were on at least their third such admission. All but three patients underwent preoperative rigid proctosigmoidoscopy. Fifty-five of the 58 patients were treated with STC and primary ileorectal anastomosis. The major causes of bleeding were diverticular disease only (68%), angiodysplasia only (12%) and both diseases (12%). Overall mortality was 17%, with the main contributor being sepsis resulting from anastomotic leak. Non-fatal complications occurred in 20%, resulting in a mean postoperative length of stay of 13 days. All patients were doing well on their first follow-up visit with a mean number of four stools per day after 1 month.

CONCLUSION

While emergency STC is an effective and definitive method of treating unlocalised massive LGIB, its associated morbidity and mortality may limit its usefulness.

Segmental vs. extended colectomy: measurable differences in morbidity, function, and quality of life

PURPOSE

The colon coordinates fecal elimination while reabsorbing excess fluid. Extended colonic resection removes synchronous and prevents metachronous disease but may adversely alter bowel function and health-related quality of life to a greater degree than segmental resection. This study examined the short-term morbidity and long-term function and quality of life after colon resections of different extents.

METHODS

Patients undergoing extended resections (n = 201, subtotal colectomy with ileosigmoid or total abdominal colectomy with ileorectal anastomosis) and segmental colonic resections (n = 321) during 1991 to 2003 were reviewed for perioperative outcomes and surveyed for bowel function and quality of life using an institutional questionnaire and a validated quality of life instrument (response rate: 70 percent).

RESULTS

The most common indication for extended resections was multiple polyps, and for segmental resections, single malignancy. The complication-free rate was 75.4 percent after segmental resections, 42.8 percent after ileosigmoid anastomosis, and 60 percent after ileorectal anastomosis. Median daily stool frequency was two after segmental resections, four after ileosigmoid anastomosis, and five after ileorectal anastomosis, despite considerable dietary restrictions (55.6 percent) and medication use (19.6 percent daily) after ileorectal anastomosis. Significant proportions of patients felt restricted from preoperative social activity (31.5 percent), housework (20.4 percent), recreation (31.5 percent), and travel (42.6 percent) after ileorectal anastomosis. The overall quality of life after segmental resection, ileosigmoid anastomosis, and ileorectal anastomosis was 98.5, 94.9, and 91.2, respectively.

CONCLUSIONS

Measurable compromises in long-term bowel function and quality of life were observed after extended vs. segmental resections. The relative differences in patient-related outcomes should be deliberated against the clinical benefits of extended resection for the individual patient.

Functional outcomes of two types of subtotal colectomy for slow-transit constipation: ileosigmoidal anastomosis and cecorectal anastomosis

BACKGROUND

Some patients with severe slow-transit constipation may benefit from subtotal colectomy, but there is no consensus on standard operative mode. The aim of the study was to compare the functional outcomes of subtotal colectomy with cecorectal anastomosis (CRA) with those of subtotal colectomy with ileosigmoidal anastomosis (ISA) in patients with severe slow-transit constipation.

METHODS

Records of 79 patients who received preoperative investigation to confirm slow transit at our institution from 1989 to 2004 and subsequently received colectomy with CRA (n = 34) or colectomy with ISA (n = 45) were reviewed. The mean follow-up was 2 years (range 1-15).

RESULTS

Postoperative defecation frequency increased and symptoms such as bloating and abdominal pain decreased in both groups. More CRA patients than ISA patients experienced persistent constipation and continued using laxatives or enemas at the 12-month follow-up. More ISA patients (93.3%) than CRA patients (73.5%) were satisfied with the procedure, whereas some patients in both groups complained of excessively high stool frequency and fecal incontinence.

CONCLUSION

Both CRA and ISA procedures increase the number of bowel movements; however, ISA results in higher defecation frequency, less use of laxatives and enemas, and higher patient satisfaction.