Bowel function and quality of life after minimally invasive colectomy with D3 lymphadenectomy for right-sided colon adenocarcinoma

Table 1 Patient demographics and operative data

	n = 57
Age (yr)	63.8 (36-80)
Male/female	30 (52.6)/27 (47.4)
Body mass index (kg/m2)	23.7 (18.6-33.9)
Location of lesion
Appendix	3 (5.3)
Cecum	9 (15.8)
Ascending colon	33 (57.9)
Hepatic flexure colon	7 (12.3)
Transverse colon	5 (8.8)
Operation type
Laparoscopy	56 (98.2)
Robot	1 (1.8)
Procedure
Right hemicolectomy	47 (82.5)
Extended right hemicolectomy	10 (17.5)
Resected bowel length (cm)	36.3 (19.0-69.5)
Colon	26.7 (9.5-56.0)
Ileum	9.9 (3.2-35.5)
Preoperative obstruction	10 (17.5)
Stage
0	8 (14.0)
1	11 (19.3)
2	19 (33.3)
3	14 (24.6)
4	5 (8.8)

Values are presented as mean (range) or n (%).

Table 2 Assessment of quality of life, function, and symptoms

	Preoperative (n = 57)	3 mo (n = 47)	6 mo (n = 52)	12 mo (n = 52)	18 mo (n = 25)	P value1	P value2
Global health status/QOL
Global health status/QOL	59.5	72.2	73.4	74.0	74.0	0.001	0.145
Functional scales
Physical functioning	87.4	87.8	86.4	90.0	88.3	0.530	0.591
Role functioning	86.8	87.9	91.7	96.5	98.7	0.001	0.716
Emotional functioning	81.9	90.6	94.4	97.1	99.3	< 0.001	0.795
Cognitive functioning	91.2	92.2	93.3	95.5	94.0	0.104	0.291
Social functioning	81.6	87.6	91.0	96.5	97.3	< 0.001	0.135
Sum	428.9	446.1	456.8	475.6	477.6	< 0.001	0.568
Symptom scales/items
Fatigue	22.4	21.3	16.9	10.9	12.0	0.001	0.207
Nausea and vomiting	8.8	2.1	2.6	2.2	0.0	0.001	0.470
Pain	17.8	8.5	7.1	1.6	2.0	< 0.001	0.278
Dyspnea	9.9	6.4	10.9	3.8	1.3	0.021	0.059
Insomnia	14.6	17.0	12.8	6.4	4.0	0.009	0.005
Appetite loss	18.7	9.2	10.3	1.3	1.3	< 0.001	0.285
Constipation	18.1	7.1	10.3	5.8	5.3	0.006	0.066
Diarrhea	15.8	12.8	12.2	7.1	5.3	0.010	0.909
Financial difficulties	21.1	14.2	16.0	5.8	9.3	< 0.001	0.115
Sum	147.3	98.6	98.9	44.9	40.7	< 0.001	0.017
Chemotherapy	0	18 (38.3)	18 (34.6)	1 (1.9)	0	NA	NA
FOLFOX	0	17 (36.2)	17 (32.7)	1 (1.9)	0	NA	NA
FL	0	1 (2.1)	1 (1.9)	0	0	NA	NA

¹P values correspond to the changes in values over the period.

²P values correspond to the correlation between scales and chemotherapy. Values are presented as mean (range) or n (%). FOLFOX: Oxaliplatin-based chemotherapy regimen; FL: 5-fluorouracil with leucovorin regime; QOL: Quality of life; NA: Not available.

Table 3 Assessment of bowel function and medicine use

	Preoperative (n = 57)	3 mo (n = 47)	6 mo (n = 52)	12 mo (n = 52)	18 mo (n = 25)	P value1	P value2
Gas	3.6	3.1	2.3	1.6	0.8	< 0.001	0.023
Leakage	0.4	0.2	0.2	0.1	0	0.025	0.691
Frequency	1.7	1.8	1.2	1.3	0.5	0.014	< 0.001
Fragmentation	2.9	2.2	2.2	1.4	1.2	0.037	0.858
Urgency	3.8	2.6	3.9	2.4	2.0	0.217	0.532
Score	12.4	10.0	9.9	6.8	4.5	< 0.001	0.053
Dysfunction group						0.014	0.028
No	44 (77.2)	41 (87.2)	43 (82.7)	47 (90.4)	24 (96.0)
Minor	5 (8.8)	4 (8.5)	4 (7.7)	3 (5.8)	1 (4.0)
Major	8 (14.0)	2 (4.3)	5 (9.6)	2 (3.8)	0
Medicine	5 (8.8)	6 (12.8)	6 (11.5)	5 (9.6)	2 (8.0)	0.882
Antidiarrheal agent	1 (1.8)	2 (4.3)	1 (1.9)	1 (1.9)	0	0.558
Bulking agent	0	2 (4.3)	1 (1.9)	1 (1.9)	2 (8.0)	0.161
Stool softener	3 (5.3)	4 (8.5)	4 (7.7)	1 (1.9)	2 (8.0)	0.764
Other	1 (1.8)	0	0	3 (5.8)	0	0.447

¹P values correspond to the changes of values over the period.

²P values correspond to the correlation between the scales and medication. Values are presented as mean (range) or n (%).

Table 4 Relationship of quality of life and bowel function

	Gas		Leakage		Frequency		Fragmentation		Urgency		Bowel score		Dysfunction group
	CC	P value	CC	P value	CC	P value	CC	P value	CC	P value	CC	P value	CC	P value
Global health status/QOL
	-0.138	0.035	-0.091	0.165	-0.129	0.049	-0.090	0.170	-0.095	0.150	-0.166	0.011	-0.145	0.027
Functional scales
Physical	-0.048	0.464	0.010	0.883	-0.155	0.018	-0.023	0.728	-0.087	0.186	-0.107	0.104	-0.103	0.118
Role	-0.027	0.679	-0.052	0.433	-0.197	0.003	-0.011	0.870	-0.085	0.195	-0.108	0.099	-0.067	0.306
Emotional	-0.145	0.027	-0.199	0.002	-0.249	< 0.001	-0.194	0.003	-0.193	0.003	-0.301	< 0.001	-0.242	< 0.001
Cognitive	-0.067	0.306	-0.041	0.529	-0.193	0.003	-0.168	0.010	-0.176	0.007	-0.234	< 0.001	-0.186	0.004
Social	-0.220	0.001	-0.170	0.009	-0.026	0.695	-0.150	0.022	-0.156	0.017	-0.233	< 0.001	-0.179	0.006
Sum	-0.137	0.037	-0.123	0.062	-0.217	0.001	-0.139	0.034	-0.183	0.005	-0.258	< 0.001	-0.203	0.002
Symptom scales/items
FA	0.025	0.704	0.007	0.918	0.138	0.035	0.194	0.003	0.261	< 0.001	0.268	< 0.001	0.213	0.001
NV	0.108	0.101	-0.056	0.394	0.137	0.036	0.154	0.018	0.232	< 0.001	0.254	< 0.001	0.255	< 0 .001
PA	0.159	0.015	0.090	0.172	0.133	0.042	0.056	0.396	0.118	0.073	0.173	0.008	0.138	0.036
DY	0.044	0.502	-0.007	0.913	-0.014	0.832	-0.007	0.915	0.192	0.003	0.118	0.073	0.065	0.322
SL	0.096	0.143	-0.007	0.915	0.117	0.074	0.152	0.021	0.308	< 0.001	0.293	< 0.001	0.207	0.002
AP	0.140	0.033	-0.003	0.960	0.088	0.183	-0.003	0.958	0.090	0.172	0.110	0.094	0.083	0.204
CO	0.098	0.135	-0.605	0.325	0.404	< 0.001	0.034	0.609	0.016	0.806	0.134	0.040	0.087	0.184
DI	0.048	0.463	0.356	< 0.001	-0.055	0.401	0.311	< 0.001	0.355	< 0.001	0.360	< 0.001	0.368	< 0.001
FI	0.168	0.010	0.076	0.247	0.070	0.291	0.089	0.173	0.095	0.148	0.161	0.014	0.118	0.073
Sum	0.165	0.011	0.080	0.224	0.196	0.003	0.184	0.005	0.306	< 0.001	0.349	< 0.001	0.282	< 0.001

FA: Fatigue; NV: Nausea and vomiting; PA: Pain; DY: Dyspnea; SL: Insomnia; AP: Appetite loss; CO: Constipation; DI: Diarrhea; FI: Financial difficulties; CC: Correlation coefficients.

Table 5 Risk factors in the bowel dysfunction group (minor and major groups) six months after surgery

Reference	Univariate		Multivariate
	P value	OR	P value	OR
Age (yr)	0.826	1.008
Sex (male)	0.229	0.396
Body mass index (kg/m2)	0.325	1.108
Lesion	0.769	-
Operation type (laparoscopy)	1.000	3.462
Operation name (right hemicolectomy)	0.536	0.568
Resected bowel length (cm)	0.026	1.095	0.297	1.093
Colon	0.031	1.147	0.415	1.048
Ileum	0.386	1.048
Preoperative obstruction (no)	0.938	-
Stage	0.980	-

OR: Odds ratio.