Comparison of short-term and medium-term outcomes between intracorporeal anastomosis and extracorporeal anastomosis for laparoscopic left hemicolectomy

Abstract

Background Few studies have evaluated the feasibility and safety of intracorporeal anastomosis (IA) for left hemicolectomy. Here, we aimed to investigate the potential advantages and disadvantages of laparoscopic left hemicolectomy with IA and compare the short- and medium-term outcomes between IA and extracorporeal anastomosis (EA). Methods We retrospectively analyzed 133 consecutive patients who underwent laparoscopic left hemicolectomies from July 2016 to September 2019 and categorized them into the IA and EA groups. Patients with stage 4 disease and conversion to laparotomy or those lost to follow-up were excluded. Postoperative outcomes between IA and EA groups were compared. Short-term outcomes included postoperative pain score, bowel function recovery, complications, duration of hospital stay, and pathological outcome. Medium outcomes included overall survival and disease-free survival for at least 2 years. Results After excluding ineligible patients, the remaining 117 underwent IA (n = 40) and EA (n = 77). The IA group had a shorter hospital stay, a shorter time to tolerate liquid or soft diets, and higher serum C-reactive protein level on postoperative day 3. There was no difference between two groups in operative time, postoperative pain, specimen length, or nearest margin. A 2-year overall survival (IA vs. EA: 95.0% vs. 93.5%, p = 0.747) and disease-free survival (IA vs. EA: 97.5% vs. 90.9%, p = 0.182) rates were comparable between two groups. Conclusions Laparoscopic left hemicolectomy with IA was technically feasible, with better short-term outcomes, including shorter hospital stays and shorter time to tolerate liquid or soft diets. The IA group had higher postoperative serum C-reactive protein level; however, no complications were observed. Regarding medium-term outcomes, the overall survival and disease-free survival rates were comparable between IA and EA procedures.

Minimally Invasive Left Colectomy with Total Intracorporeal Anastomosis versus Extracorporeal Anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation

“…IA has been associated with shortened hospital stay in some studies, [30,33] though others have not found signi cant differences. The same applies to operating time: IA is associated with a longer surgical time in most comparative studies, though the difference is not always signi cant.…”

Intracorporeal Versus Extracorporeal Colo-colic Anastomosis in Minimally-invasive Left Colectomy: a Systematic Review and Meta-analysis

“…The male to female ratio was 436:271 in 7 studies 28 – 34 with available demographic data for IA and EA patients undergoing left colectomy. Except for 3 studies 30 , 31 , 34 with a multi-center design, 5 studies 28 , 29 , 32 , 33 , 35 were single-center studies. The operative indication was malignant tumors in 7 studies 28 – 34 while Teramura et al 35 also included benign diseases.…”

“…of included studies No. of included patients SMD/OR [95% CI] p -value Heterogeneity level IA EA I 2 (%) Chi 2 ( p -value) Primary Severe complications * 6 28 , 30 , 31 , 33 – 35 282 376 0.66 [0.30–1.46] 0.30 36 0.18 Intra-abdominal fluid/abscess 8 28 – 35 335 415 0.69 [0.26–1.82] 0.45 0 0.79 Anastomotic leak 8 28 – 35 335 415 0.61 [0.24–1.56] 0.30 0 0.83 Anastomotic bleeding 8 28 – 35 335 415 3.14 [0.81–12.21] 0.10 0 0.97 Postoperative transfusion 4 28 – 31 170 155 0.84 [0.19–3.81] …”

Comparison of intracorporeal and extracorporeal anastomosis for left or sigmoid colectomy: updated meta-analysis of retrospective control trials

“…5 There are two anastomosis procedures containing intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) for reestablishing intestinal transit in colorectal surgery. 6,7 Initially, EA is commonly used for intestinal anastomosis. However, EA in laparoscopic-assisted colectomy requires the mobilization of the small intestine and colon and pulling on the mesentery as the bowel is withdrawn, which theoretically leads to more surgical injury.…”

“…9,11,12 Most researches that compared IA and EA techniques mainly focus on the right side of the colon, instead of the colon cancer lacated in the distal transverse, splenic fexure and descending parts of the colon. 7 Furthermore, the choice of IA and EA methods for left or sigmoid colectomy is controversial due to the comprehension on the feasibility and effectiveness of the two anastomosis techniques is unclear. Aiming to provide a robust guideline for surgeons, this systematic review provide an a complete overview of studies comparing the two techniques.…”