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Segmental vs. Extended Colectomy: Measurable Differences in Morbidity, Function, and Quality of Life

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

The colon coordinates fecal elimination while reabsorbing excess fluid. Extended colonic resection removes synchronous and prevents metachronous disease but may adversely alter bowel function and health-related quality of life to a greater degree than segmental resection. This study examined the short-term morbidity and long-term function and quality of life after colon resections of different extents.

Methods

Patients undergoing extended resections (n = 201, subtotal colectomy with ileosigmoid or total abdominal colectomy with ileorectal anastomosis) and segmental colonic resections (n = 321) during 1991 to 2003 were reviewed for perioperative outcomes and surveyed for bowel function and quality of life using an institutional questionnaire and a validated quality of life instrument (response rate: 70 percent).

Results

The most common indication for extended resections was multiple polyps, and for segmental resections, single malignancy. The complication-free rate was 75.4 percent after segmental resections, 42.8 percent after ileosigmoid anastomosis, and 60 percent after ileorectal anastomosis. Median daily stool frequency was two after segmental resections, four after ileosigmoid anastomosis, and five after ileorectal anastomosis, despite considerable dietary restrictions (55.6 percent) and medication use (19.6 percent daily) after ileorectal anastomosis. Significant proportions of patients felt restricted from preoperative social activity (31.5 percent), housework (20.4 percent), recreation (31.5 percent), and travel (42.6 percent) after ileorectal anastomosis. The overall quality of life after segmental resection, ileosigmoid anastomosis, and ileorectal anastomosis was 98.5, 94.9, and 91.2, respectively.

Conclusions

Measurable compromises in long-term bowel function and quality of life were observed after extended vs. segmental resections. The relative differences in patient-related outcomes should be deliberated against the clinical benefits of extended resection for the individual patient.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA

    Y. Nancy You M.D., M.H.Sc., Heidi K. Chua M.D. & Heidi Nelson M.D.

  2. Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA

    Imran Hassan M.D.

  3. Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

    Sunni A. Barnes Ph.D. & Jeffrey Harrington M.A.

Authors
  1. Y. Nancy You M.D., M.H.Sc.
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  2. Heidi K. Chua M.D.
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  3. Heidi Nelson M.D.
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  4. Imran Hassan M.D.
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  5. Sunni A. Barnes Ph.D.
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  6. Jeffrey Harrington M.A.
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Correspondence to Heidi Nelson M.D..

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You, Y.N., Chua, H.K., Nelson, H. et al. Segmental vs. Extended Colectomy: Measurable Differences in Morbidity, Function, and Quality of Life. Dis Colon Rectum 51, 1036–1043 (2008). https://doi.org/10.1007/s10350-008-9325-1

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  • DOI: https://doi.org/10.1007/s10350-008-9325-1

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