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.
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.
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.
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.
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Conflict of interest
The authors declare that they have no conflict of interest.
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 was obtained from all individual participants included in the study.
The members of the RCC study group are listed in “Appendix.”
The Right Colectomy for Cancer study group (RCC group) consists of: Prof. Arne Olav Bakka MD, Akershus University Hospital, Department of Digestive Surgery, University of Oslo, Norway; Prof. Bjorn Edwin MD, Interventional Centre, Gastrointestinal and Pediatric Surgery, Oslo University Hospital–Rikshospitalet, Oslo, Norway; Arne Engebreth Faerden MD, Ph.D., Akershus University Hospital, Department of Digestive Surgery, University of Oslo, Norway; Morten Tandberg Eriksen, MD, Akershus University Hospital, Department of Digestive Surgery, University of Oslo, Norway; Aly Dicko MD Department of Digestive Surgery, Haukeland University Hospital, Bergen, Norway; Håvard Forsmo, MD, Department of Digestive Surgery, Haukeland University Hospital, Bergen, Norway; Hege Aase Saetran MD, Department of Pathology, Haukeland University Hospital, Bergen, Norway; Markus Brun, MD, Akershus University Hospital, Department of Digestive Surgery, University of Oslo, Norway.
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Thorsen, Y., Stimec, B., Andersen, S.N. et al. Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy. Tech Coloproctol 20, 445–453 (2016). https://doi.org/10.1007/s10151-016-1466-y