Left Colon Surgery in Adults: Indications, Surgical Procedures and Complications in Douala, Cameroon – A Multicenter Retrospective Study

Abstract

Background: Left colon surgery represents a major component of digestive surgical practice worldwide, with colorectal cancer being the leading indication. In sub-Saharan Africa, delayed presentation and emergency surgery remain frequent, potentially influencing postoperative outcomes. Objective: To describe indications, surgical procedures, postoperative complications, and factors associated with postoperative morbidity following left colon surgery in adults in Douala, Cameroon. Methods: This was a retrospective, analytical multicenter study conducted in four referral hospitals in Douala over 11 years (January 2013–December 2023). Adult patients (≥15 years) who underwent left colon surgery were included. Data were analyzed using SPSS version 25.0. Associations between potential risk factors and postoperative complications were assessed using univariate analysis, with p < 0.05 considered statistically significant. Results: Among 223 colon surgeries performed during the study period, 144 left colon procedures were included (64.6%). The mean age was 50 ± 15 years, with male predominance. Emergency admission accounted for 72.2% of cases. Neoplastic pathology represented 75% of indications, predominantly colorectal adenocarcinoma. Postoperative complications occurred in 8.3% of patients, with anastomotic fistula accounting for 33.3% of complications. The overall mortality rate was 2.8%. Emergency surgery, advanced tumor stage, and sigmoid colon localization were significantly associated with postoperative morbidity. Conclusion: Left colon surgery in Douala is largely dominated by colorectal cancer and is frequently performed in emergency settings. Emergency presentation and advanced disease significantly increase postoperative morbidity, highlighting the importance of early diagnosis and elective surgical management.