Analysis of Morbidity and Mortality, Quality of Life and bowel function after Total Colectomy with ileorectal anastomosis, compared to Right and Left Hemicolectomy: a study to optimise treatment of Lynch syndrome

Emanuele Damiano Luca Urso, Francesco Celotto, Riccardo Bao Quoc, Isacco Maretto, Salvatore Pucciarelli

Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy


In Lynch syndrome total colectomy with ileorectal anastomosis (IRA) is proposed as optimal treatment when surgery is aimed. In Literature there are not robust data on complications, quality of life and bowel function comparing patients who underwent total colectomy with ileorectal anastomosis (which is widely proposed as the best treatment for Lynch syndrome cases) or segmental resection. AIM: to collect surgical and functional data after IRA versus segmental hemicolectomy to integrate informed consent

METHODs: consecutive IRA (8-15 cm from anal verge) patients (group A), matched by age, sex, BMI, ECOG performance score, cancer size and stage, technique (open/lap) with right (group B) or left (group C) hemicolectomy cases; surgery: 2001-2016. EORTC-QLQ CR-30, CR-29 and MSKCC questionnaires sent to investigate Quality of Life (QoL) and bowel function (b.f.) at 69 months (median) from surgery. Morbidity: Clavien-Dindo (C-D) classification. Statistical analysis: Mann-Whitney Test for continuous and χ-square for categorical variables

RESULTS: 55 patients in each group; their age, sex, BMI, ECOG p.s., cancer size, open/lap ratio are not different (p>.05). Median hospital stay, overall and severe complications (C-D stage III-IV) and mortality: not different between the groups; surgery longer in group A than control groups (p<.0001)

MSKCC questionnaire analysis revealed worse b.f. in group A, but QLQ CR-30 and CR-29 demonstrated worse score in group A only for bowel frequency related items.

CONCLUSION: IRA and segmental resections have similar complications. The worse b.f. in IRA patients do not impairs severely QoL.