Intracorporeal versus Extracorporeal Anastomosis for Laparoscopic Right Hemicolectomy: Short-Term Outcomes

Abstract

Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis (ICA) vs. extracorporeal anastomosis (ECA); the secondary outcome was the number of lymph nodes retrieved. This observational study was conducted on 108 patients who underwent right hemicolectomy for RCC; after surgical resection, 64 patients underwent ICA and 44 underwent ECA. The operative time was slightly longer in the ICA group than in the ECA group, even though the difference was not significant (199.31 ± 48.90 min vs. 183.64 ± 35.80 min; p = 0.109). The length of hospital stay (7.53 ± 1.91 days vs. 8.77 ± 3.66 days; p = 0.036) and bowel function recovery (2.21 ± 1.01 days vs. 3.45 ± 1.82 days; p < 0.0001) were significantly lower in the ICA group. There were no significant differences in postoperative complications (12% in ICA group vs. 9% in ECA group), wound infection (6% in ICA group vs. 7% in ECA group), or anastomotic leakage (6% in ICA group vs. 9% in ECA group). We did not observe a significant difference between the two groups in the number of lymph nodes collected (19.46 ± 7.06 in ICA group vs. 22.68 ± 8.79 in ECA group; p = 0.086). ICA following laparoscopic right hemicolectomy, compared to ECA, could lead to a significant improvement in bowel function recovery and a reduction in the length of hospital stay in RCC patients.

Pathological and perioperative outcomes of extracorporeal versus intracorporeal anastomosis in laparoscopic transverse colon cancer resection: retrospective multicentre study

“…This can be explained by more mesocolon tissue being removed during this procedure, as attested by the greater length of resected intestines in ICA. Other studies found no statistically significant difference in lymph node harvest between the two groups 11 , 34 , 39 . However, these studies, including the current study, were all retrospective studies with limited sample sizes.…”

Robotic versus laparoscopic right hemicolectomy: a systematic review of the evidence

“…As a consequence of extra-corporeal anastomosis, analysis of retrospective cohort study from the Cleveland clinic revealed that the midline was chosen as an extraction site during laparoscopic right hemicolectomy in 88.7% of patients, whereas a C-section was only used in a minority of patients [ 21 ]. The preferential choice of midline as an extraction site during laparoscopic right hemicolectomy and/or extra-corporeal anastomosis was confirmed by other reports [ 14 , 15 , 22 – 24 ], and unfortunately exposes patients to increased risks of wound-related complications, notably incisional hernia. For instance, a systematic review and meta-analysis estimated the pooled incidence of incisional hernia at the extraction site after laparoscopic colorectal surgery to be of 10.6% when using the midline and 0.9% when using a C-section [ 25 ].…”

“…After the publication of several trials showing that laparoscopy offered similar oncological outcomes for improved recovery outcomes for minimally invasive right hemicolectomy [ 1 – 5 ], laparoscopy has become the standard approach for performing the procedure [ 6 – 8 ]. Nowadays, laparoscopic right hemicolectomy consists mostly in laparoscopic mobilization of the colon, extra-corporeal vessel division and lymphadenectomy (at least at the level of the ileo-colic vessels), extra-corporeal anastomosis and extraction through the midline [ 6 , 9 , 12 , 14 , 15 , 21 – 24 ]. However, fully minimally invasive right hemicolectomy should theoretically include intra-corporeal vessel division, lymphadenectomy and anastomosis, allowing to use a C-section as extraction site.…”

Implementation of totally robotic right hemicolectomy: lessons learned from a prospective cohort

“…It also allows more careful assessment and dissection when encountering T4 invasion. We believe that recovery of the bowel function may constitute a better primary outcome, as robotics allows finer dissection of the tissues, facilitates the realization of intra-corporeal (which is associated with better post-operative outcomes [ 10 , 13 – 16 ]) and was shown by meta-analyses of observational studies to shorten the time to flatus and first stools [ 25 , 29 , 30 ]. Moreover, robotics facilitates the realization of minimally invasive complete mesocolic excision for those who perform the technique.…”

“…Because of the technical limitations of laparoscopy, most centres adopted extra-corporeal anastomosis [ 7 ] and midline incision as the extraction site [ 10 – 12 , 14 ] as the standard of care during lapRHC. However, intra-corporeal anastomosis [ 10 , 13 – 16 ] and off-midline extraction sites [ 10 , 17 ] are associated with better post-operative outcomes. Considering that robotics provides finer tissue dissection and facilitates realization of intra-corporeal anastomosis [ 7 , 18 ], robotics could potentially improve the outcomes of minimally invasive RHC when compared to lapRHC.…”