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Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers

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Abstract

Background

Although nowadays considered as feasible and effective surgery in terms of short- and long-term results and oncological radicality, laparoscopic right colectomy is performed by a small number of surgeons, and in the vast majority of cases, this technique was performed with an extracorporeal anastomosis. Current literature failed to solve the controversies between intracorporeal and extracorporeal anastomosis after laparoscopic right colectomy.

Methods

A multicenter case-controlled study has been designed, including 286 patients who underwent laparoscopic right hemicolectomy with intracorporeal anastomosis (IA) compared with 226 matched patients who underwent laparoscopic right hemicolectomy with extracorporeal anastomosis (EA).

Results

There was no significant difference in terms of age, sex, BMI, and ASA score between the two groups. Surgical post history, tumor localization, and stage of disease according to AJCC/UICC TNM were similar too. Although similar oncologic radicality in term of number of lymph nodes harvested (25.7 ± 10.7 of IA group vs. 24.8 ± 8.7 of EA group; p = 0.3), as well as similar operative time (166 ± 43.7 min. in IA group vs. 157.5 ± 67.2 min in EA group) have been registered, time to flatus was statistically lower after intracorporeal anastomosis (40.8 ± 24.3 h in TLRC group vs. 55.2 ± 19.2 h in LARC group; p < 0.001) Laparoscopic colectomy with intracorporeal anastomosis was associated with a lower rate of post-operative complications (OR 0.65, 95 % CI 0.44, 0.95, p = 0.027). However, when stratifying according to clavien classification, the difference was consistently confirmed for less severe (class I and II) complications (OR 0.63, 95 % CI 0.42, 0.94, p = 0.025), but not for class III, IV, and V complications (OR 1.015, 95 % CI 0.64, 1.6, p = 0.95).

Conclusion

Our results are encouraging to consider the intracorporeally approach the better way to fashion the anastomosis after laparoscopic right colectomy. This study clearly provides the rationale for a randomized clinical trial, which would be useful to give definitive conclusion.

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Disclosure

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Authors and Affiliations

  1. University “Federico II”, Via Pansini 5, 80131, Naples, Italy

    Marco Milone, Enrico Di Salvo, Luigi Bucci, Giuseppe Paolo Ferulano, Umberto Bracale, Michele D’ambra, Gaetano Luglio, Mario Musella & Francesco Milone

  2. San Raffaele Scientific Institute, University Vita Salute, Milan, Italy

    Ugo Elmore, Maria Rachele Angiolini & Riccardo Rosati

  3. C-National Cancer Institute G. Pascale, Naples, Italy

    Paolo Delrio & Ugo Pace

  4. Ruggi d’Aragona Hosipal, Salerno, Italy

    Carmine Napolitano & Marco Clemente

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  1. Marco Milone
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Correspondence to Marco Milone.

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Marco Milone and Ugo Elmore equally contributed to this paper.

Riccardo Rosati and Francesco Milone share co-seniorship of this paper.

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Milone, M., Elmore, U., Di Salvo, E. et al. Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc 29, 2314–2320 (2015). https://doi.org/10.1007/s00464-014-3950-7

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