Intracorporeal Anastomosis Versus Extracorporeal Anastomosis in Laparoscopic Right Colectomy: An Observational Cohort Study

Abstract

Background Current studies did not draw definitive conclusions on comparison of intracorporeal anastomosis (ICA) with extracorporeal anastomosis (ECA) in laparoscopic right colectomy. Whether the intraperitoneal contamination induced by ICA can result in higher risk of postoperative abdominal infection remains unclear. This study was aimed to compare the short‐term outcomes, especially the risk of abdominal infection after ICA versus ECA. Methods This was an observational cohort study as a secondary analysis of a randomized controlled trial (RCT)—RELARC trial (NCT02619942). The patients enrolled in the RELARC trial were diagnosed with primary colon adenocarcinoma without distant metastasis and underwent radical laparoscopic right colectomy between Jan 2016 and Dec 2019. In our study the patients who converted to open surgery in RELARC trial were excluded. The short‐term outcomes were compared between ICA and ECA. The primary endpoint was abdominal infection. The inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) was used for adjusting the potential confounders. Results This study enrolled 975 patients with 119 patients undergoing ICA and 856 patients undergoing ECA. The incidence of abdominal infection was higher in ICA group (9.2% versus 1.5%, RR from IPTW = 5.7 (95%CI: 2.6–12.6), P < 0.001) as well as the incidence of wound infection (14.3% vs 3.3%, RR from IPTW = 5.0 (95%CI: 2.9–8.6), P < 0.001). ICA was associated with higher incidence of Clavien–Dindo (CD) grade I and II complications (CD‐I: 15.1% versus 6.8%, RR from IPTW = 2.4 (95%CI: 1.5–3.9), P < 0.001; CD‐II: 26.9% versus 8.2%, RR from IPTW = 3.6 (95%CI: 2.5–5.1), P < 0.001) but similar incidence of CD‐III ~ IV complications compared to ECA (3.4% vs 2.1%, RR from IPTW = 1.2 (95%CI: 0.4–4.0), P = 0.73). In ICA group, choosing another incision rather than lengthening main port site decreased the incidence of wound infection although without statistical significance (17.3% (14/81) versus 7.9% (3/38), crude RR = 2.2 (95%CI: 0.7–7.2), P = 0.17). Conclusion ICA is likely to be associated with higher risk of abdominal infection and CD‐I ~ II complications.

Laparoscopic assisted colectomy versus laparoscopic complete colectomy: a cost analysis

“…In terms of pathological outcomes, LCC/IA was associated with significantly more dissected lymph nodes; however, the statistical difference disappeared after PSM. The result aligned with previous studies demonstrating higher amount of harvested lymph nodes with the IA method [31,32]. This finding reflected the fact that LCC/IA could offer better visualization of the bowel to perform complete exposure of the mesenteric base and vascular ligation under a fully laparoscopic view.…”

Author's Reply: Intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right colectomy: An observational cohort study

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We are very pleased to receive the letter from other researchers who are also interested in the intracorporeal anastomosis technique. 1 We also agree with the opinion that post hoc analysis has lots of limitations in adjusting the confounding factors, but we think the results of our research is intriguing to look into the advantages and potential disadvantages of ICA technique.As for the decision of ICA or ECA, almost all the ICA were unselectively performed by two surgeons in two centers, which result in such difference compared with ECA (119 vs. 856). These two surgeons accomplished more than 100 laparoscopic surgeries for colon cancer.For ICA procedure, the surgeon did not care about the tension of anastomosis, since it was made inside the abdominal cavity, which may result in wider resection margins and higher node retrievals.

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“…We are very pleased to receive the letter from other researchers who are also interested in the intracorporeal anastomosis technique. 1 We also agree with the opinion that post hoc analysis has lots of limitations in adjusting the confounding factors, but we think the results of our research is intriguing to look into the advantages and potential disadvantages of ICA technique.…”

Enhancing Outcomes Through Preoperative Risk Evaluation in Colorectal Cancer Surgery

“…Therefore, the choice of surgical method is particularly crucial, with a preference for laparoscopic surgery when possible [115,116]. Research indicates that in a single-center randomized controlled trial, the postoperative incision infection rate for patients undergoing laparoscopic surgery for colorectal cancer was 4.9% (47/961), signi cantly lower than the open surgery group (9.6%, 95/986) [117,118,119,120]. This difference may be due to laparoscopic surgery reducing the direct contact between organs and environmental pathogens.…”