Among the remaining 34 responders (Table 3), the overall colectomy-free rate after 1 year was 61%, 38% after 3 years and 35% after 7 years.
The overall resort to colectomy was 72%, while 19% of the patients remained colectomy-free.
The overall need for colectomy remains high in these patients and toxicity must be monitored.
Given the results reported from previous studies of the possible involvement of the intestinal microbiota in atherosclerosis, 6 8–10 18 we expected a considerably reduced risk of CVD in patients who had their presumed overall harmful intestinal microbiota reduced by colectomy.
For laparoscopic surgery, the COST Study Group trial has proved the advantages of laparoscopy for colon cancer, especially in faster perioperative recovery and shorter hospital stays, with the similar recurrence and overall survival rates to the open-colectomy group [ 1].
Previous studies have reported that total colectomy does not significantly improve the overall survival of LS patients, and the surgical procedure should be selected based on individual patient factors and preferences [24, 25].
Since the greatest part by far of the gut microbiota is carried in the colon, we suggest that patients who have had a total colectomy and have been carrying the overall harmful microbiota will benefit from the removal of the colon, whereas those carrying the beneficial microbiota will either not be affected by this procedure or be less likely to suffer from an increased CVD risk.
Although the data is limited, we believe that this approach allows us to buy time and improve the patients overall condition so that the patient is able to withstand colectomy at a later date.
32 Since hypertension is a well-established risk factor for most of the other CVDs, it is plausible that the overall, though insignificant, tendency to a lower CVD risk after colectomy may be due to an effect on blood pressure.
A previous report also showed that for patients with ASA classifications of 3 and 4, laparoscopic colectomy was associated with similar postoperative mortality but less overall morbidity, quicker return of bowel function, and shorter length of hospital stay compared with open colectomy [17].
The Clinical Outcomes in Surgical Therapy trial demonstrated that laparoscopic colectomy (LC) was equivalent to open colectomy (OC) for 30-day mortality, time to recurrence, and overall survival in colon cancer (CC) patients.
