Zhobin Moghadamyeghaneh, MD, Joseph C Carmichael, MD, Steven D Mills, MD, Alessio Pigazzi, MD, Michael J Stamos, MD. University of California, Irvine
There is limited data regarding the surgical factors associated with prolonged postoperative ileus in colon surgery. We sought to compare prolonged postoperative ileus in different kinds of colon resection and bowel anastomosis in patients with the diagnosis of colon cancer.
The NSQIP databases were used to examine the clinical data of patients undergoing colon resection with the diagnosis of colon cancer in 2012. Multivariate regression analysis was performed to compare different resections regarding prolonged ileus (no return of bowel function in 7 days).
We sampled a total of 3,920 patients who underwent colon resections. A total of 14.7% of the patients had prolonged ileus. Patients who had prolonged ileus had more than three times increased rate of anastomotic leak (AOR: 3.01, P<0.01). The highest rate of prolonged postoperative ileus existed in total colectomy with ileorectal anastomosis (27.2%) followed by segmental colonic resection with colocolonic anastomosis (15.2%). The lowest rate of prolonged ileus followed sigmoidectomy with colorectal anastomosis (13%). In multivariate analysis, compared to sigmoidectomy with colorectal anastomosis, total colectomy with ileorectal anastomosis procedure had significantly higher risk of prolonged ileus (AOR: 2.89, P<0.01). Also, factors such as hypoalbuminemia (AOR: 1.55, P<0.01), open surgery (AOR: 1.79, P<0.01), and non-elective surgery (AOR: 1.38, P<0.01) were associated with prolonged ileus.
Prolonged ileus is a common condition following colon resection (incidence rate of 14.7%). Patients with prolonged ileus had three times higher rate of anastomotic leak, which points out the need to consider a leak in any patient with prolonged ileus. Following a colon resection for cancer, total colectomy with ileorectal anastomosis and sigmoidectomy have the highest and the lowest rates respectively, of prolonged postoperative ileus.