Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study

Abstract

Backgrounds Though better short-term outcomes were frequently reported, differences in specimen parameters and the rate of subsequent peritoneal recurrence between intracorporeal anastomosis (IA) and extracorporeal anastomoses (EA) for laparoscopic right hemicolectomy have not been analyzed. We aimed to compare the pathologic differences and oncological outcomes between these two approaches. Methods We retrospectively analyzed 217 consecutive patients who underwent laparoscopic right hemicolectomies from September 2016 to April 2018 and classified them into IA and EA groups, based on the approach used. Propensity score matching analysis was performed, after which 101 patients were included in each group with the patients matched for demographics, tumor stage, and localization. Results The IA group had a longer operative time, shorter length of stay, shorter time to first flatus and tolerating a soft diet, and better pain scale scores at postoperative day 3. No inter-group differences in conversion, postoperative complication, mortality, or readmission rates were found. The IA group had a longer resected colon length (23.67 vs. 19.75 cm, p = 0.010) and nearest resected margin (7.51 vs. 5.40 cm, p = 0.010) for cancer near the hepatic flexure. There are comparable 3-year overall survival (87.7% vs. 89.6%, p = 0.604) and disease-free survival (75.0% vs. 75.7%, p = 0.842) between the IA and EA groups. The rate of peritoneal recurrence was similar between the two groups (5.9% vs. 7.9%, p = 0.580). Conclusions The overall survival, disease-free survival, and the rate of peritoneal recurrence were comparable between the IA and EA procedures. IA ensures better recovery and comparable complications to EA and achieved a more precise tumor excision; thus, IA can be considered a safe procedure for patients with right-sided colon lesions.

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

“…Although the median times to first flatus (IA vs. EA: 2.1 days vs. 2.5 days) or first stool passage (IA vs. EA: 3.7 days vs. 4.6 days) appeared shorter in the IA group than in the EA group, these differences were not statistically significant. The IA group showed faster resumption of liquid and soft diets than the EA group in this study, which is consistent with findings from other reports [ 19 – 21 ] and our previous study on right hemicolectomy with IA [ 22 ]. This finding might result from less tissue manipulation and minor bowel mobilization during colectomy and anastomosis in the IA group.…”

Does liver cirrhosis affect the surgical outcome of primary colorectal cancer surgery? A meta-analysis

“…Radical resection of the colorectal tumors has been widely accepted as a curative treatment [8]. Tumor location, comorbidity, clinical stage, anastomosis methods, and total mesorectal excision are reported to have an effect on the outcome of CRC surgery [9][10][11][12].…”

Accelerated 23-h enhanced recovery protocol for colon surgery: the CHASE-study

“…The use of short-acting total intravenous anesthesia (propofol, remifentanil and ketamine (analgesic dosage) in combination with the pre-induction spinal anesthesia; Restrictive fluid management with continuous perfusion of Ringer Lactate 3 ml/kg/h; Deep neuromuscular blockade (Rocuronium bromide perfusion) Lung protective ventilation (Total Volume 6-8 ml/kg; minimum FiO2 and optimal PEEP) Adequate temperature regulation with forced air warming and core temperature monitoring; Starting intra-abdominal pressure at 12 mmHg with a gradual decrease to 8 mmHg 29,30 Minimally invasive surgery with intracorporal anastomosis [31][32][33][34][35][36][37] Extraction of specimen through a suprapubic Pfannenstiel incision, no additional mini-laparotomy performed 38…”