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

Li-Ming Wang; Bor-Kang Jong; Chun-Kai Liao; Ya-Ting Kou; Yih-Jong Chern; Yu-Jen Hsu; Pao-Shiu Hsieh; Wen-Sy Tsai; Jeng-Fu You

doi:10.1186/s12957-022-02735-7

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

World J Surg Oncol. 2022 Aug 27;20(1):270. doi: 10.1186/s12957-022-02735-7.

Authors

Li-Ming Wang¹, Bor-Kang Jong¹, Chun-Kai Liao¹, Ya-Ting Kou¹, Yih-Jong Chern¹, Yu-Jen Hsu¹, Pao-Shiu Hsieh¹, Wen-Sy Tsai¹, Jeng-Fu You²

Affiliations

¹ Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan.
² Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, No. 5, Fuxing Street, Guishan District, Taoyuan City, Taiwan. jenodyssey@gmail.com.

Abstract

Background: Few studies have evaluated the feasibility and safety of intracorporeal anastomosis (IA) for left hemicolectomy. Here, we aimed to investigate the potential advantages and disadvantages of laparoscopic left hemicolectomy with IA and compare the short- and medium-term outcomes between IA and extracorporeal anastomosis (EA).

Methods: We retrospectively analyzed 133 consecutive patients who underwent laparoscopic left hemicolectomies from July 2016 to September 2019 and categorized them into the IA and EA groups. Patients with stage 4 disease and conversion to laparotomy or those lost to follow-up were excluded. Postoperative outcomes between IA and EA groups were compared. Short-term outcomes included postoperative pain score, bowel function recovery, complications, duration of hospital stay, and pathological outcome. Medium outcomes included overall survival and disease-free survival for at least 2 years.

Results: After excluding ineligible patients, the remaining 117 underwent IA (n = 40) and EA (n = 77). The IA group had a shorter hospital stay, a shorter time to tolerate liquid or soft diets, and higher serum C-reactive protein level on postoperative day 3. There was no difference between two groups in operative time, postoperative pain, specimen length, or nearest margin. A 2-year overall survival (IA vs. EA: 95.0% vs. 93.5%, p = 0.747) and disease-free survival (IA vs. EA: 97.5% vs. 90.9%, p = 0.182) rates were comparable between two groups.

Conclusions: Laparoscopic left hemicolectomy with IA was technically feasible, with better short-term outcomes, including shorter hospital stays and shorter time to tolerate liquid or soft diets. The IA group had higher postoperative serum C-reactive protein level; however, no complications were observed. Regarding medium-term outcomes, the overall survival and disease-free survival rates were comparable between IA and EA procedures.

Keywords: Disease-free survival; Extracorporeal anastomosis; Intracorporeal anastomosis; Laparoscopy surgery; Left hemicolectomy.

MeSH terms

Anastomosis, Surgical
C-Reactive Protein
Colectomy
Colonic Neoplasms*
Humans
Laparoscopy*
Pain, Postoperative
Retrospective Studies
Treatment Outcome

Substances

C-Reactive Protein