Intracorporeal Versus Extracorporeal Anastomosis in Robotic Right Colectomy

Abstract

Objective: To determine if minimally invasive right colectomy with intracorporeal anastomosis improves postoperative recovery compared to extra-corporeal anastomosis. Background: Previous trials have shown that intracorporeal anastomosis improves postoperative recovery; however, it has not yet been evaluated in a setting with optimized perioperative care or with patient-related outcome measures. Methods: This was a multicenter, triple-blind, randomized clinical trial at two high-volume colorectal centers with strict adherence to optimized perioperative care pathways. The patients underwent robotic right colectomy with either intracorporeal or extracorporeal anastomosis. The primary outcome was patient-reported postoperative recovery measured using the "Quality of Recovery-15" questionnaire. ClinicalTrials.gov NCT03130166. Results: A total of 89 patients were randomized and analyzed according to the "Intention-to-treat"-principle. We found no statistically significant differences in patient-reported recovery between the groups. Postoperative pain, nausea, time to ambulation, time to first passage of flatus/ stool, length of hospital stay, and pathophysiological tests showed no differences either. The duration of time to create the anastomosis was significantly longer with intracorporeal anastomosis (17 vs 13 min, P = 0.003), while all other intraoperative, postoperative, and pathology variables showed no difference. Conclusion: There were no significant differences in postoperative recovery between the two groups.

Right hemicolectomy for colon cancer: does the anastomotic configuration affect short‐term outcomes?

“…For example, the oversewing of double stapled anastomosis has been shown to be protective for anastomotic leak ( P = 0.03), 21 however, this information is currently not available in the BCOR. Intra‐corporeal anastomotic techniques have also been associated with faster return of bowel function, although with no difference in length of stay or complication rates such as anastomotic leak or post‐operative bleeding 26–29 . These factors may be of interest in future analyses.…”

“…Intra-corporeal anastomotic techniques have also been associated with faster return of bowel function, although with no difference in length of stay or complication rates such as anastomotic leak or post-operative bleeding. [26][27][28][29] 29 These factors may be of interest in future analyses.…”

A novel knotless hand-sewn end-to-end anastomosis using V-loc barbed suture vs. stapled anastomosis in laparoscopic left colonic surgery: A propensity scoring match analysis

“…Several studies have shown that that ICA has advantages over ECA such as shorter length of incision, less estimated blood loss, and shorter time to bowel function recovery ( 2 , 17 , 18 ). However, two recent high-quality randomized controlled trials ( 8 , 19 ) and one study on robotic left colectomy ( 20 ) failed to show that outcomes after ICA were better than after ECA. The advantages of the KHEA technique could be a further argument in favor of the ICA technique.…”

“…Left hemicolectomy may sometimes be a complex procedure [mobilization of the splenic flexure, unexpected adhesions or tumor invasion, intraoperative vascular problems (5,6). Complete laparoscopic colectomy with an intracorporeal reconstruction technique requires advanced surgical skills and may increase operation time, hospitalization costs, and/or the risk of abdominal contamination (7)(8)(9).…”

Technical aspects of performing intracorporeal anastomosis in laparoscopic right hemicolectomy

“…The literature currently reports multiple benefits of intracorporeal anastomosis compared to extracorporeal anastomosis, for example earlier recovery of bowel function, less postoperative pain, utility in obese patients with shortened mesentery, clear visualization of bowel orientation, and equivalent anastomotic leak and 30‐day morbidity rates. [1–4]…”