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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Prevalence of and risk factors for morbidity after elective left colectomy: Cancer vs noncomplicated diverticular disease
Archives of Surgery, Volume 146, No. 10, Year 2011
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Description
Hypothesis: Independent risk factors for postoperative morbidity after colectomy are most likely linked to disease characteristics. Design: Retrospective analysis. Setting: Twenty-eight centers of the French Federation for Surgical Research. Patients: In total, 1721 patients (1230 with colon cancer [CC] and 491 with diverticular disease [DD]) from a databank of 7 prospective, multisite, randomized trials on colorectal resection. Intervention: Elective left colectomy via laparotomy. Main Outcome Measures: Preoperative and intraoperative risk factors for postoperative morbidity. Results: Overall postoperative morbidity was higher in CC than in DD (32.4% vs 30.3%) but the difference was not statistically significant (P=.40). Two independent risk factors for morbidity in CC were antecedent heart failure(odds ratio [OR], 3.00; 95% confidence interval [CI], 1.42-6.32) (P=.003) and bothersome intraluminal fecal matter (2.08; 1.42-3.06) (P=.001). Three independent risk factors for morbidity in DD were at least 10% weight loss (OR, 2.06; 95% CI, 1.25-3.40) (P=.004), body mass index (calculated as weight in kilograms divided by height in meters squared) exceeding 30 (2.05; 1.15-3.66) (P=.02), and left hemicolectomy (vs left segmental colectomy) (2.01; 1.19-3.40) (P=.009). Conclusions: Patients undergoing elective left colectomy for CC or for DD constitute 2 distinct populations with completely different risk factors for morbidity, which should be addressed differently. Improving colonic cleanliness (by antiseptic enema) may reduce morbidity in CC. In DD, morbidity may be reduced by appropriate preoperative nutritive support (by immunonutrition), even in patients with obesity, and by preference of left segmental colectomy over left hemicolectomy. By decreasing morbidity, mortality should be lowered as well, especially when reoperation becomes necessary. ©2011 American Medical Association. All rights reserved.
Authors & Co-Authors
Piessen, Guillaume
France, Lille
Chu Lille
Muscari, Fabrice
France, Toulouse
Hôpital Rangueil
Rivkine, Emmanuel
France, Poissy
Centre Hospitalier Intercommunal Poissy-st-germain-en-laye
Sbaï-Idrissi, Mohammed Saïd
France, Eaubonne
Hôpital Simone Veil
Lorimier, Gérard
France, Angers
Anticancer Center Papin
Fingerhut, Abraham L.
France, Poissy
Centre Hospitalier Intercommunal Poissy-st-germain-en-laye
Greece, Athens
School of Medicine
Dziri, Chadli
Tunisia, Tunis
Université de Tunis el Manar, Hôpital Charles Nicolle
Hay, Jean Marie
France, Colombes
Hopital Louis-mourier
Statistics
Citations: 32
Authors: 8
Affiliations: 8
Identifiers
Doi:
10.1001/archsurg.2011.231
e-ISSN:
15383644
Research Areas
Cancer
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study
Case-Control Study