Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer

Abstract

Laparoscopic right hemicolectomy with extracorporeal anastomosis is a widely used procedure; several authors have published their approach to intracorporeal anastomosis. In this paper, we present an approach developed by us and compare short-term outcomes with those of extracorporeal anastomosis in colon cancer patients.Retrospective review of colon cancer patients treated with laparoscopic right hemicolectomy either with intracorporeal anastomosis (TLG group) or extracorporeal anastomosis (LG group) at the Zhangjiagang Hospital Affiliated to Soochow University between January 2011 and October 2015. Operative and postoperative data are compared.Around 85 patients underwent laparoscopic hemicolectomy (56 TLG and 29 LG) during the reference period for this study. Age, gender, body mass index (BMI), stage of cancer, operation time, number of lymph nodes harvested, and length of hospital stay were comparable between the 2 groups. In the TLG group, the ileocolic anastomosis time was significantly shorter (9.9–15.5 minutes vs 13.5–18.2 minutes in LG; P < 0.001), the mean intraoperative blood loss was lower (83.2 mL [range, 56.5–100.5 mL] vs 93.3 mL [range, 75.8 – 110.3 mL]; P < 0.001), the recovery of bowel function was faster (P < 0.001), and the postoperative pain score was lower (P < 0.001) as compared to that in the LG group. Complications in the LG group included wound infection (4 patients), obstruction (1), and postoperative bleeding complications (1); however, only 1 patient developed complication (wound infection) in the TLG group.Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal anastomosis for colon cancer is a safe and reliable procedure. Its advantages include short anastomosis time, less intraoperative blood loss, less postoperative pain, and early bowel function recovery.

Comparative study between hand sewn and stapled anastomosis in laparoscopic right hemicolectomy

“…But in the study of Jian-Cheng et al, who had mean resuming oral intake of 27±7 hours in the stapled group while the meantime of resuming the oral intake in the hand sewn group was 54±9 hours. 6,7 The mean hospital stay in the first group in this study was 4.47±2.13 days and in the second group the mean hospital stay was 6.60±1.30 days in agreement with the study of Phelan MJ et al, where the hospital stay after the operation in the stapled group was 3±2 days and in the hand sewn group the mean was 6±1 days. 7 But in disagreement with Jian-Cheng et al, who had the mean hospital stay after operation in the first group 10±2 days and in the second group the mean was 12±1 day.…”

“…In the study by Jian-Cheng et al, evaluating the shortterm outcomes in total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer, the ratio was males to females (68.9% to 31.1%) from 29 cases in the hand sewn anastomosis while in stapled anastomosis the ratio between males to females was (57.1% to 42.9%) from 65 cases and the mean age was 68.0±8.3 years in agreement with this study. 6 The main presenting symptoms in cancer colon are anemia and weight loss, the cases of the first group in this research presented by weight loss were 10 patients (66.7%) and anemia in 9 patients (60%), while in the second group the cases were presented by weight loss 9 cases (60%), anemia 9 cases (60%).…”

“…The complication rate is lower than that of the other study in the form of wound site infection, which is due to the good pull up bowel during the anastomosis, and in leakage due the meticulous anastomosis technique. 6 In the study by Bhandary et al, in the stapled group 35 cases with no leakage and in the hand sewn group 35 cases there was 1 case complicated by leakage and was managed conservatively with excellent match in both studies. 11…”

“…7 But in disagreement with Jian-Cheng et al, who had the mean hospital stay after operation in the first group 10±2 days and in the second group the mean was 12±1 day. 6 In the study by Thakor et al, hospital stay in the stapled group (34 cases) was 11.59 days and in the hand sewn group (34 cases) it was 12.69 days. 9 In the first group of this study, there was 1 case complicated by leakage from anastomosis (6.2%) which was presented by abdominal pain, tenderness, vomiting and the drain collected serosanguineous fluid about 100 cc and was managed by pelvi-abdominal ultrasound, where minimal to moderate fluid collection was detected and treated conservatively by NPO, antibiotic, TPN and observation of the drain.…”

Laparoscopic colectomies associated with decreased retrieval of 12 or more lymph nodes compared to open in elective colon cancer surgery

“…Most studies achieved greater than 12 LNs using various procedures, such as laparoscopic complete mesocolic excision (CME), open CME, CME with complete vascular ligation, laparoscopic radical LN dissection including non-regional LNs, robotic surgery, intra-and extracorporeal laparoscopic surgery, single-and multi-port laparoscopic surgery, 2D versus 3D laparoscopic surgery and even a multidisciplinary approach [4][5][6][7][8][9][10][11][12][13][14][15].…”