title: Prevalence of and risk factors for morbidity after elective left colectomy: cancer vs noncomplicated diverticular disease.
abstract: OBJECTIVE
  Independent risk factors for postoperative morbidity after colectomy are most likely linked to disease characteristics.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Twenty-eight centers of the French Federation for Surgical Research.
  
  
  METHODS
  In total, 1721 patients (1230 with colon cancer [CC] and 491 with diverticular disease [DD]) from a databank of 7 prospective, multisite, randomized trials on colorectal resection.
  
  
  METHODS
  Elective left colectomy via laparotomy.
  
  
  METHODS
  Preoperative and intraoperative risk factors for postoperative morbidity.
  
  
  RESULTS
  Overall postoperative morbidity was higher in CC than in DD (32.4% vs 30.3%) but the difference was not statistically significant (P = .40). Two independent risk factors for morbidity in CC were antecedent heart failure (odds ratio [OR], 3.00; 95% confidence interval [CI], 1.42-6.32) (P = .003) and bothersome intraluminal fecal matter (2.08; 1.42-3.06) (P = .001). Three independent risk factors for morbidity in DD were at least 10% weight loss (OR, 2.06; 95% CI, 1.25-3.40) (P = .004), body mass index (calculated as weight in kilograms divided by height in meters squared) exceeding 30 (2.05; 1.15-3.66) (P = .02), and left hemicolectomy (vs left segmental colectomy) (2.01; 1.19-3.40) (P = .009).
  
  
  CONCLUSIONS
  Patients undergoing elective left colectomy for CC or for DD constitute 2 distinct populations with completely different risk factors for morbidity, which should be addressed differently. Improving colonic cleanliness (by antiseptic enema) may reduce morbidity in CC. In DD, morbidity may be reduced by appropriate preoperative nutritive support (by immunonutrition), even in patients with obesity, and by preference of left segmental colectomy over left hemicolectomy. By decreasing morbidity, mortality should be lowered as well, especially when reoperation becomes necessary.
authors: Department of General and Digestive Surgery, Hôpital Huriez, Centre Hospitalier Universitaire, Lille, France.
authors: Guillaume
authors: G
authors: Piessen
authors: Fabrice
authors: F
authors: Muscari
authors: Emmanuel
authors: E
authors: Rivkine
authors: Mohamed Saïd
authors: MS
authors: Sbaï-Idrissi
authors: Gérard
authors: G
authors: Lorimier
authors: Abe
authors: A
authors: Fingerhut
authors: Chadli
authors: C
authors: Dziri
authors: Jean-Marie
authors: JM
authors: Hay
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003082:Colectomy / Q000009:adverse effects* / Q000401:mortality; D003110:Colonic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D004241:Diverticulum, Colon / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors