Intracorporeal or Extracorporeal Ileocolic Anastomosis After Laparoscopic Right Colectomy

Abstract

Objectives: The aim of the study was to determine whether there are clinically relevant differences in outcomes between laparoscopic right colectomy (LRC) with intracorporeal ileocolic anastomosis (IIA) and LRC with extracorporeal IA (EIA). Background: IIA and EIA are 2 well-established techniques for restoration of bowel continuity after LRC. There are no high-quality studies demonstrating the superiority of one anastomotic technique over the other. Methods: This is a double-blinded randomized controlled trial comparing the outcomes of LRC with IIA and LRC with EIA in patients with a benign or malignant right-sided colon neoplasm. Primary endpoint was length of hospital stay (LOS). This trial was registered with ClinicalTrials.gov, number NCT03045107. Results: A total of 140 patients were randomized and analyzed. Median operative time was comparable in IIA versus EIA group {130 [interquartile range (IQR) 105–195] vs 130 (IQR 110–180) min; P = 0.770} and no intraoperative complications occurred. The quicker recovery of bowel function after IIA than EIA [gas: 2 (IQR 2–3) vs 3 (IQR 2–3) days, P = 0.003; stool: 4 (IQR 3–5) vs 4.5 (IQR 3–5) days, P = 0.032] was not reflected in any advantage in the primary endpoint: median LOS was similar in the 2 groups [6 (IQR 5–7) vs 6 (IQR 5–8) days; P = 0.839]. No significant differences were observed in the number of lymph nodes harvested, length of skin incision, 30-day morbidity (17.1% vs 15.7%, P = 0.823), reoperation rate, and readmission rate between the 2 groups. Conclusions: LRC with IIA is associated with earlier recovery of postoperative bowel function than LRC with EIA; however, it does not reflect into a shorter LOS.

Comment on: Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial)

“…As the third randomized trial on this topic, Bollo et al . seem to be in line with the results of other studies, reinforcing the advantages of IA.…”

“…Postoperative outcomes favoured IA for both bowel function recovery and pain, but with no differences in time to first oral intake, severity of complications, median length of hospital stay, 30‐day morbidity rate, incisional hernia rate or median number of lymph nodes. Although not statistically significant, the anastomotic leak rate in IA was higher than in EA (8·6 versus 2·9 per cent).…”

“…No significant differences were recorded for anastomotic leak rate, wound infection rate, severity of complications (Grade III), length of hospital stay, readmission rate and oncological findings. A single‐centre, double‐blinded, RCT study by Allaix et al . compared IA and EA techniques.…”

The feasibility and safety of complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction in right-transverse colon cancer

“…On the one hand, a recent meta-analysis including 3755 patients found that in IA, time to rst atus, time to defecation, time to liquid diet, hospital length of stay, postoperative infections and overall complications were estimated to be lower [22] . On the other hand, Kang Hong Lee et.al [23] found that the number of retrieved lymph nodes, the overall survival and the disease-free survival at three years were not signi cantly different between IA and EA. The resection and anastomosis need not be performed extracorporeally for IA and therefore a smaller portion of the intestine is required to be freed laparoscopically.…”

“…In fact, the surgeon is able to perform a less invasive surgery on the basis of radical oncological outcomes. Since the development of intracorporeal anastomosis [8] , complete laparoscopic extended hemicolectomy with preserving the ileocecal junction may be an optional procedure for right-transverse colon cancer. Therefore, we try to apply this procedure in the laparoscopic treatment for right-transverse colon cancer and explore its safety and feasibility.…”