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Invited Critique |

Learning to Recycle Comment on “Prevalence of and Risk Factors for Morbidity After Elective Left Colectomy”

James W. Fleshman, MD
Arch Surg. 2011;146(10):1156. doi:10.1001/archsurg.2011.232.
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This study by Piessen et al1 presents patient data accumulated in previous randomized controlled trials to answer critical clinical questions that require many patients. The French consortium should be congratulated on their outstanding management of data and the ability to reaccess these data points to answer more questions.

Unfortunately, the trials and the patient populations are diverse, and the original trial may have nothing to do with the question that is being asked on a second data analysis. Patients in the original studies who underwent left colectomy showed a difference in morbidity between CC and DD after initial analysis. Variations in the patient population inclusion and exclusion criteria for the initial trials, as well as in the medical severity index for the 2 groups, may explain the differences in morbidity. Older patients with CC more often required infraperitoneal colorectal anastomoses, were a predominantly male group with assumed narrow pelvis, experienced an increase in fecal contamination during the procedure, and had higher incidences of anemia, ascites, cirrhosis, chronic obstructive pulmonary disease, congestive heart failure, wound healing issues, and bowel strictures. Patients with DD had a higher body mass index but had experienced a recent 10% weight loss and were found to have undrained or uncontrolled sepsis present in the abdomen at the time of an elective operation. These significant differences make it difficult to identify predictors of morbidity.

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