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Techniques in Coloproctology

, Volume 20, Issue 7, pp 445–453 | Cite as

Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy

  • Y. Thorsen
  • B. Stimec
  • S. N. Andersen
  • J. C. Lindstrom
  • F. Pfeffer
  • T. Oresland
  • D. Ignjatovic
  • RCC study group
Original Article

Abstract

Background

The aim of this study was to ascertain the impact of injury to the superior mesenteric nerve plexus caused by right colectomy with D3 extended mesenterectomy as performed in the prospective multicenter trial: “Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-detector Computed Tomography” in which all soft tissue surrounding the superior mesenteric vessels from the level of the middle colic artery to that of the ileocolic artery was removed.

Methods

Bowel function and gastrointestinal quality of life in two consecutive cohorts that underwent right colectomy with and without D3 extended mesenterectomy were compared. Main outcome measures were the Diarrhea Assessment Scale (DAS) and Gastrointestinal Quality of Life Index (GIQLI). The data were collected prospectively through telephone interviews.

Results

Forty-nine patients per group, comparable for age, sex, length of bowel resected but with significantly shorter follow-up time in the experimental group, were included. There was no difference in total DAS scores, subscores or additional questions except for higher bowel frequency scores in the D3 group (p = 0.02). Comparison of total GIQLI scores and subscales showed no difference between groups. Regression analysis with correction for confounding factors showed 0.48 lower bowel frequency scores in the D2 group (p = 0.022). Within the D3 group presence of jejunal arteries cranial to the D3 dissection area showed 1.78 lower DAS scores and 0.7 lower bowel frequency scores.

Conclusions

Small bowel denervation after right colectomy with D3 extended mesenterectomy leads to increased bowel frequency but does not impact gastrointestinal quality of life. Individual anatomical variants can affect postoperative bowel function differently despite standardized surgery.

Keywords

Right hemicolectomy Colorectal cancer Mesenterectomy Superior mesenteric plexus Bowel motility 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This bowel function and quality of life study as well as the multicenter trial “Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-detector Computed Tomography” have been approved by the national research ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag Italia Srl 2016

Authors and Affiliations

  • Y. Thorsen
    • 1
    • 7
  • B. Stimec
    • 2
  • S. N. Andersen
    • 3
  • J. C. Lindstrom
    • 4
  • F. Pfeffer
    • 5
    • 6
  • T. Oresland
    • 1
    • 7
  • D. Ignjatovic
    • 1
  • RCC study group
  1. 1.Department of Digestive Surgery, Akershus University HospitalUniversity of OsloLorenskogNorway
  2. 2.Anatomy Sector, Department of Cellular Physiology and Metabolism, Faculty of MedicineUniversity of GenevaGenevaSwitzerland
  3. 3.Department of Pathology, Akershus University HospitalUniversity of OsloLorenskogNorway
  4. 4.Helse Sør-Øst Health Services Research CenterAkershus University HospitalLorenskogNorway
  5. 5.Department of Clinical MedicineUniversity of BergenBergenNorway
  6. 6.Department of SurgeryHaukeland University HospitalBergenNorway
  7. 7.Institute of Clinical MedicineUniversity of OsloOsloNorway

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