Overview of colon resection
- Miguel A Rodriguez-Bigas, MD
Miguel A Rodriguez-Bigas, MD
- Professor of Surgery
- MD Anderson Cancer Center
Colon resection is needed to manage a variety of malignant and benign colon lesions, including trauma. Planning colon resection needs to take into account the nature of the lesion and its location within the colon.
The general issues surrounding resecting the colon are reviewed here. Techniques for colon resection are reviewed separately. (See "Right and extended right colectomy: Open technique" and "Left colectomy: Open technique".)
INDICATIONS FOR COLON RESECTION
The indications for colon resection include benign and malignant conditions.
●Malignant and premalignant colon lesions (see "Surgical resection of primary colon cancer")
●Appendiceal cancer (see "Cancer of the appendix and pseudomyxoma peritonei")
- Neuman HB, Weiss JM, Leverson G, et al. Predictors of short-term postoperative survival after elective colectomy in colon cancer patients ≥ 80 years of age. Ann Surg Oncol 2013; 20:1427.
- Deierhoi RJ, Dawes LG, Vick C, et al. Choice of intravenous antibiotic prophylaxis for colorectal surgery does matter. J Am Coll Surg 2013; 217:763.
- Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73.
- Nelson RL, Glenny AM, Song F. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2009; :CD001181.
- Zhu QD, Zhang QY, Zeng QQ, et al. Efficacy of mechanical bowel preparation with polyethylene glycol in prevention of postoperative complications in elective colorectal surgery: a meta-analysis. Int J Colorectal Dis 2010; 25:267.
- Cao F, Li J, Li F. Mechanical bowel preparation for elective colorectal surgery: updated systematic review and meta-analysis. Int J Colorectal Dis 2012; 27:803.
- Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011; :CD001544.
- Ikeda A, Konishi T, Ueno M, et al. Randomized clinical trial of oral and intravenous versus intravenous antibiotic prophylaxis for laparoscopic colorectal resection. Br J Surg 2016; 103:1608.
- Morris MS, Graham LA, Chu DI, et al. Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery. Ann Surg 2015; 261:1034.
- Wren SM, Ahmed N, Jamal A, Safadi BY. Preoperative oral antibiotics in colorectal surgery increase the rate of Clostridium difficile colitis. Arch Surg 2005; 140:752.
- Kiran RP, Murray AC, Chiuzan C, et al. Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 2015; 262:416.
- Nelson RL, Gladman E, Barbateskovic M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2014; :CD001181.
- Lewis RT. Oral versus systemic antibiotic prophylaxis in elective colon surgery: a randomized study and meta-analysis send a message from the 1990s. Can J Surg 2002; 45:173.
- Krapohl GL, Phillips LR, Campbell DA Jr, et al. Bowel preparation for colectomy and risk of Clostridium difficile infection. Dis Colon Rectum 2011; 54:810.
- Chen M, Song X, Chen LZ, et al. Comparing Mechanical Bowel Preparation With Both Oral and Systemic Antibiotics Versus Mechanical Bowel Preparation and Systemic Antibiotics Alone for the Prevention of Surgical Site Infection After Elective Colorectal Surgery: A Meta-Analysis of Randomized Controlled Clinical Trials. Dis Colon Rectum 2016; 59:70.
- http://www.who.int/gpsc/global-guidelines-web.pdf?ua=1 (Accessed on November 09, 2016).
- Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:381S.
- Zaghiyan KN, Sax HC, Miraflor E, et al. Timing of Chemical Thromboprophylaxis and Deep Vein Thrombosis in Major Colorectal Surgery: A Randomized Clinical Trial. Ann Surg 2016; 264:632.
- Bonjer HJ, Hop WC, Nelson H, et al. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 2007; 142:298.
- Jackson TD, Kaplan GG, Arena G, et al. Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes. J Am Coll Surg 2007; 204:439.
- Siddiqui MR, Sajid MS, Khatri K, et al. Elective open versus laparoscopic sigmoid colectomy for diverticular disease: a meta-analysis with the Sigma trial. World J Surg 2010; 34:2883.
- Bartels SA, Gardenbroek TJ, Ubbink DT, et al. Systematic review and meta-analysis of laparoscopic versus open colectomy with end ileostomy for non-toxic colitis. Br J Surg 2013; 100:726.
- Sammour T, Kahokehr A, Srinivasa S, et al. Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg 2011; 253:35.
- Reza MM, Blasco JA, Andradas E, et al. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 2006; 93:921.
- Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH. Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 2010; 211:232.
- Webb S, Rubinfeld I, Velanovich V, et al. Using National Surgical Quality Improvement Program (NSQIP) data for risk adjustment to compare Clavien 4 and 5 complications in open and laparoscopic colectomy. Surg Endosc 2012; 26:732.
- Neale JA, Reickert C, Swartz A, et al. Accuracy of national surgery quality improvement program models in predicting postoperative morbidity in patients undergoing colectomy. Perm J 2014; 18:14.
- Yamada T, Okabayashi K, Hasegawa H, et al. Meta-analysis of the risk of small bowel obstruction following open or laparoscopic colorectal surgery. Br J Surg 2016; 103:493.
- Watanabe J, Ota M, Fujii S, et al. Randomized clinical trial of single-incision versus multiport laparoscopic colectomy. Br J Surg 2016; 103:1276.
- Ayav A, Bresler L, Hubert J, et al. Robotic-assisted pelvic organ prolapse surgery. Surg Endosc 2005; 19:1200.
- Munz Y, Moorthy K, Kudchadkar R, et al. Robotic assisted rectopexy. Am J Surg 2004; 187:88.
- Heemskerk J, Zandbergen R, Maessen JG, et al. Advantages of advanced laparoscopic systems. Surg Endosc 2006; 20:730.
- Heemskerk J, de Hoog DE, van Gemert WG, et al. Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum 2007; 50:1825.
- Sonoda T, Milsom JW. Section 5: Gastrointestinal tract and abdomen. Chapter 34: Segmental colon resection.ACS Surgery: Principles and Practice http://www.acssurgery.com/acs/chapters/ch0534.htm (Accessed on November 07, 2011).
- Chang GJ, Kaiser AM, Mills S, et al. Practice parameters for the management of colon cancer. Dis Colon Rectum 2012; 55:831.
- Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Short-term outcomes after complete mesocolic excision compared with 'conventional' colonic cancer surgery. Br J Surg 2016; 103:581.
- Neutzling CB, Lustosa SA, Proenca IM, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2012; :CD003144.
- Delaney CP, Fazio VW, Senagore AJ, et al. 'Fast track' postoperative management protocol for patients with high co-morbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 2001; 88:1533.
- Basse L, Hjort Jakobsen D, Billesbølle P, et al. A clinical pathway to accelerate recovery after colonic resection. Ann Surg 2000; 232:51.
- Basse L, Thorbøl JE, Løssl K, Kehlet H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004; 47:271.
- Behrns KE, Kircher AP, Galanko JA, et al. Prospective randomized trial of early initiation and hospital discharge on a liquid diet following elective intestinal surgery. J Gastrointest Surg 2000; 4:217.
- Di Fronzo LA, Cymerman J, O'Connell TX. Factors affecting early postoperative feeding following elective open colon resection. Arch Surg 1999; 134:941.
- DiFronzo LA, Yamin N, Patel K, O'Connell TX. Benefits of early feeding and early hospital discharge in elderly patients undergoing open colon resection. J Am Coll Surg 2003; 197:747.
- Delaney CP, Zutshi M, Senagore AJ, et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 2003; 46:851.
- Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 2007; 245:867.
- Pemberton JH. Colonic absorption. Perspectiv Colon Rectal Surg 1988; 1:89.
- Warner BW. Short- and long-term complications of colectomy. J Pediatr Gastroenterol Nutr 2009; 48 Suppl 2:S72.
- Wright HK. The functional consequences of colectomy. Am J Surg 1975; 130:532.
- Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group. Lancet 2000; 356:968.
- Chautard J, Alves A, Zalinski S, et al. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg 2008; 206:255.
- Frasson M, Braga M, Vignali A, et al. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum 2008; 51:296.
- Longo WE, Virgo KS, Johnson FE, et al. Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 2000; 43:83.
- Hinojosa MW, Konyalian VR, Murrell ZA, et al. Outcomes of right and left colectomy at academic centers. Am Surg 2007; 73:945.
- Amri R, Bordeianou LG, Sylla P, Berger DL. Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery. Am J Surg 2014; 207:17.
- INDICATIONS FOR COLON RESECTION
- Benign disease
- PREOPERATIVE EVALUATION
- Medical risk assessment
- Preoperative imaging
- PREOPERATIVE PREPARATION
- Intravenous antimicrobial prophylaxis
- Bowel preparation
- Prophylactic ureteral stenting
- Anticipated splenectomy
- MINIMALLY INVASIVE COLON RESECTION
- Short-term (perioperative) outcomes
- - Overall morbidity
- - Severe morbidity
- - Mortality
- Long-term outcomes
- COLON RESECTION
- Types of colon resection
- Benign versus malignant disease
- BOWEL ANASTOMOSIS
- Primary closure versus ostomy
- POSTOPERATIVE CARE AND FOLLOW-UP
- PERIOPERATIVE MORBIDITY AND MORTALITY
- SUMMARY AND RECOMMENDATIONS