Comparison of functional recovery and surgical outcomes of Crohn’s and Cancer patients undergoing right colectomy following an Enhanced Recovery Pathway


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A Master's thesis.
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Master (thesis) (master)
Comparison of functional recovery and surgical outcomes of Crohn’s and Cancer patients undergoing right colectomy following an Enhanced Recovery Pathway
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Université de Lausanne, Faculté de biologie et médecine
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Introduction. Crohn’s disease (CD) is a transmural, chronic and autoimmunity disease that can affect any segment of
the digestive tract. With 58%, the ileocecal segment is the most prevalent primary location of the disease and may
require ileocecal resection for disease control. Formal right colectomy is the standard approach to right-sided colon
cancer, in which a central resection with high ligation of the ileocolic axis is mandatory for complete removal of
tumor-draining lymphovascular tissue. Conversely, CD typically needs less radical resection of lymphovascular
structures and is mainly guided by the extent of the inflammatory process. The aim of this study is to compare
functional recovery and surgical outcomes of patients undergoing ileocecal resection for CD to patients with rightsided
colon cancer undergoing oncological right colectomy within a standardized enhanced recovery pathway.
Methods. This is a retrospective cohort study with data deriving from the ERAS database of the CHUV. 195 patients
(n=153 (78%) with cancer and n=42 (22%) with CD) were included. We collected demographic and surgical
information, functional outcomes (postoperative pain level, opioid use, time from surgery to return to flatus and
stool, postoperative oral intake of fluids, postoperative weight change and postoperative mobilization),
postoperative complications and some specific assessments for oncological and Crohn’s patients, including total
number of resected lymph nodes.
Results. Oncological patients were older, sicker (ASA score) and had higher BMI scores. Crohn’s group experienced
significantly more pain at POD 0-3, and significant differences were observed in intraoperative EDA use and
postoperative opioid use within 48 hours. Return of flatus and stool was similar in both groups and no difference was
seen in surgical outcome. Oncological patients gained significantly more weight and had a larger lymph node yield
than the CD group.
Conclusion. This study did not reveal differences in functional and surgical outcome in CD and cancer patients
undergoing mesentery-sparing or oncological right colectomy, respectively. Based on these data, more extensive
resection in CD patients to prevent disease recurrence may be warranted and will most likely not negatively impact
functional recovery.
Crohn’s disease, Right colectomy, Functional outcome, Surgical outcome, Postoperative recurrence
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Create date
07/09/2020 12:03
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18/02/2021 8:08
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