Risk of Metabolic Disease After Right- vs Left-Sided Colectomy for Colon Cancer: A Nationwide Cohort Study
Soo Young Oh, Jaeim Lee, Kyungdo Han, Ga Yoon Ku, Nina YooBACKGROUND:
The metabolic consequences of colon cancer surgery may vary by anatomic resection site, but direct comparisons of right- versus left-sided colectomy are limited.
OBJECTIVE:
To compare the incidence of new-onset diabetes mellitus, hypertension, and dyslipidemia after right- versus left-sided colectomy for colon cancer.
DESIGN:
Retrospective population-based cohort study.
SETTINGS:
Nationwide data from the Korean Clinical Data Utilization for Research Excellence project, linking cancer registry, insurance claims, and health screening databases.
PATIENTS:
Adults aged 30 years or older with histologically confirmed colon cancer who underwent colectomy between January 1, 2013, and December 31, 2019.
MAIN OUTCOME MEASURES:
New-onset diabetes mellitus, hypertension, and dyslipidemia occurring after colectomy. Hazard ratios were estimated with Cox models adjusted for demographics, lifestyle factors, body mass index, waist circumference, Surveillance, Epidemiology, and End Results summary stage, and treatment; Fine-Gray subdistribution models accounted for the competing risk of death. Inverse probability of treatment weighting (IPTW) was used to address residual confounding.
RESULTS:
Among 8,228 patients (mean [standard deviation] age, 58.8 [11.4] years; 4,633 [56.3%] male), 3,253 underwent right-sided and 4,975 underwent left-sided colectomy. During a median follow-up of 4.0 years (interquartile range, 2.5–5.8), 358 patients (4.4%) developed diabetes mellitus, 1,050 (12.8%) developed hypertension, and 1,167 (14.2%) developed dyslipidemia. Right-sided colectomy was associated with a 20% lower risk of incident dyslipidemia compared with left-sided colectomy (adjusted hazard ratio, 0.80; 95% confidence interval, 0.71–0.91;
LIMITATIONS:
Observational design using administrative data limits causal inference; direct measurements of bile acids, microbiome composition, or inflammatory markers were unavailable; results from a Korean population may not be generalizable to other ethnic groups.
CONCLUSIONS:
The anatomic laterality of colectomy was differentially associated with metabolic outcomes; right-sided resection was associated with a lower risk of incident dyslipidemia. These findings suggest that surgical laterality may inform postoperative metabolic risk stratification and support incorporating routine lipid monitoring into post-colectomy survivorship care. See Video Abstract .