Bowel function and quality of life after minimally invasive colectomy with D3 lymphadenectomy for right-sided colon adenocarcinoma

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.