What are the expected outcomes following colon resection (colectomy)?

Updated: Apr 05, 2021
  • Author: David E Stein, MD, MHCM; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

Outcomes after colon resection are excellent. The average length of stay at the authors’ institution is in the range of 4-5 days. As mentioned above, it is imperative to try to maintain low SSI rates by using appropriate technique and maintaining an attention to detail. Specific outcomes are based on the indication for surgery. For example, the recurrence rate after an attack of diverticulitis is less than 5%. The cancer recurrence rate is based on the final pathologic stage of the cancer.

The Clinical Outcomes of Surgical Therapy (COST) [17] and Colon Cancer Laparoscopic or Open Resection (COLOR) [18] trials found laparoscopic surgery for colon cancer to be as effective as open colectomy in preventing recurrence and death from cancer. Clinical trials also found there to be no significant increased risk of seeding tumor at port sites or spreading tumor by laparoscopic colectomy.

With respect to transverse colon cancer, which was excluded from the COST study, Agarwal et al compared laparoscopic colectomy with open colectomy for stage I-III adenocarcinoma. [19]  They found complication rate and severity, 5-year survival, and disease-free survival to be similar in the two groups, and they found the laparoscopic approach to be superior in terms of short-term recovery and lymph node harvesting.

Reports from developing countries are also showing laparoscopic surgery to have advantages over open surgery. [20]  In a case-matched analysis, Ammori et al compared laparoscopic and open right colonic resection in 69 patients with colon cancer who were comparable with respect to age, sex, size of tumor, preoperative serum albumin level, and hemoglobin level. Patients in the laparoscopic surgery group had less blood loss (50 vs 100 mL) and a shorter hospital stay (4.1 vs 6 days) but a longer operating time (200 vs 140 min). The rates of severe complications, reoperations, readmissions, and death were comparable between the two groups.

In a multicenter retrospective comparative analysis, Giordano et al compared robotic with laparoscopic sigmoid dissection in 336 patients. [21]   All of the surgeons involved had an experience of more than 50 cases using each approach annually. Propensity score matching was used to make the baseline characteristics and surgical risk factors comparable between the two groups. The laparoscopic group had a shorter operating time, whereas the robotic group had less blood loss and a shorter time to first flatus. Postoperative complication rates tended to be lower in the robotic group (5.1% vs 8.6%). Readmission and reoperative rates were lower in the robotic group (4% vs 8% and 0.5% vs 5.1%, respectively).

Fuchs et al described the outcomes of transanal hybrid colon resection (ta-CR), a NOTES (natural orifice transluminal endoscopic surgery) hybrid technique in which the transanal route was used for access, in 82 patients who had rectal prolapse, slow transit obstructive defecation, or chronic sigmoid diverticulitis. [22]  One patient had an intraoperative complication (rectal tear) that required intervention. Four patients had postoperative leakage (three of them managed laparoscopically and the fourth with open revision). The Gastrointestinal Quality of Life Index (GIQLI) improved significantly, from 89 preoperatively to 119 postoperatively.

In a systematic review and network meta-analysis of 48 trials (40 nonrandomized, 8 randomized), Tan et al reported the 5-year overall survival (OS) and disease-free survival (DFS) of several treatment strategies for acute left colonic obstruction. [23]  They found that 5-year OS and DFS were better in patients undergoing colonic stent-bridge to surgery (CS-BTS) and decompressing stoma-bridge to surgery (DS-BTS) than in those undergoing emergency surgery (ES). They also found that the 5-year OS was significantly better with DS-BTS than with CS-BTS. Transanal colorectal tube-bridge to surgery (TCT-BTS), CS-BTS, and ES had similar long-term survival rates.


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