Intraoperative and postoperative short-term outcomes of intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy

Yuhang Zhou; Yuchen Zhou; Chuandong Wang; Rong Ye; Xiaojun Lin; Song Tan; Weijie Chen; Yulong Mi; Changshun Yang; Shengtao Lin; Weihua Li

doi:10.3389/fonc.2023.1145579

Intraoperative and postoperative short-term outcomes of intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy

Front Oncol. 2023 Apr 12:13:1145579. doi: 10.3389/fonc.2023.1145579. eCollection 2023.

Authors

Yuhang Zhou^{1

2}, Yuchen Zhou³, Chuandong Wang^{1

2}, Rong Ye^{3

4}, Xiaojun Lin^{1

2}, Song Tan^{1

2}, Weijie Chen^{1

2}, Yulong Mi^{1

2}, Changshun Yang^{1

2}, Shengtao Lin^{1

2}, Weihua Li^{1

2}

Affiliations

¹ Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
² Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China.
³ The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
⁴ Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.

Abstract

Background: Intracorporeal anastomosis (IA) is a difficult but popular anastomotic approach for reconstruction of digestive tract after laparoscopic right hemicolectomy, which may reduce some limitations faced during extracorporeal anastomosis (EA).

Methods: A retrospective review of 78 patients who underwent laparoscopic right hemicolectomy by a veteran surgeon in a high-volume public tertiary hospital, including 50 patients with IA and 28 patients with EA. The intraoperative-related factors and short-term results of the two anastomotic approaches were compared.

Results: There was no significant difference in demographics and clinical characteristics between the two groups (P>0.05). The intraoperative blood loss was less (P=0.010) and the incision length was shorter (P<0.001) in the intracorporeal group. Postoperative farting time was faster (P=0.005) and postoperative pain score (VAS) was lower (P<0.001) in IA group. Although the anastomotic time of IA was shorter (P<0.001), the operative time of the two groups were similar. And number of lymph nodes harvested, NLR from POD₁ to POD₃, postoperative hospital stay and overall hospital stay between the two groups were comparable. Except for significant difference in abdominal infection rate, the Clavien-Dindo classification and the incidence of other postoperative complications were not statistically different. Moreover, the morbidity of abdominal infection decreased with time in the IA group (P=0.040).

Conclusion: IA is a reliable and feasible procedure, which has faster anastomotic time, earlier return of bowel function and superior postoperative comfort of patient, compared to EA. The postoperative complication rate of IA is similar to that of EA, and may be improved with the IA technical maturity of surgeons, which potentially contributes to the development of ERAS.

Keywords: anastomotic approach; extracorporeal anastomosis; functional end-to-end anastomosis; intracorporeal anastomosis; laparoscopic right hemicolectomy; stapled techniques.

Grants and funding

This work was supported by the Sail Fund of Fujian Medical University (grant number 2017XQ1151) and Foundation of 2020 Fujian Provincial Department of Finance Health and Health Provincial Special Subsidy.