Right extended hemicolectomy with ileo-descending anastomosis is associated with prolonged postoperative ileus and longer hospital stay compared to right or left hemicolectomy

Purpose: Prolonged postoperative ileus (PPOI) is associated with a lengthy hospital stay, risk of additional complications and substantial costs. Data regarding the incidence of PPOI following right extended colectomy (REC) with ileo-descending anastomosis is limited. This study aimed to compare the incidence of PPOI and evaluate risk factors for this condition among patients undergoing REC, left hemicolectomy (LC), and right hemicolectomy (RC) for colon carcinoma. Methods: This retrospective, single-center cohort study included patients who underwent colectomy for cancer at our institution between January 2014 and January 2022. Outcome measures were postoperative time to first bowel movement and flatus, postoperative time to tolerate a solid low-residue diet, the need for nasogastric tube (NGT) decompression or total parenteral nutrition (TPN), and length of hospital stay (LOS). Results: A total of 534 patients were included: 242 (45.3%) underwent LC, 207 (38.8%) RC, and 85 (15.9%) REC. There were no significant differences in surgical approach (laparoscopic vs. open), operative time, percentage of urgent surgeries, postoperative complication rates, or advanced T stages among the groups. Compared with LC and RC, REC was associated with a longer time to first flatus (p = 0.04), delayed tolerance of a solid diet (p < 0.001), and increased LOS (p < 0.001). Patients following REC were at a higher risk for the need of NGT decompression (p = 0.003). Analysis of covariance controlling for potential confounding variables identified REC as an independent risk factor for PPOI following surgery. Conclusion: This study revealed a higher incidence of PPOI following REC for cancer compared to RC and LC.