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The effect of intracorporeal versus extracorporeal anastomosis in robotic right colectomy on perianastomotic perfusion: a substudy to a multicenter RCT

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Abstract

Purpose

Previous studies have shown that intracorporeal anastomosis (ICA) in minimally invasive right colectomy may improve postoperative recovery compared with extracorporeal anastomosis (ECA). It has been hypothesized that creating the anastomosis extracorporeally may cause mesenteric traction and compromised intestinal perfusion. The purpose of this study was to investigate the effect of either ICA or ECA on intestinal perfusion.

Method

This was a substudy to a multicenter, triple-blind randomized clinical trial comparing ICA with ECA in patients undergoing robotic right colectomy for colonic cancer. Videos from intraoperative Indocyanine Green (ICG) fluorescence imaging were analyzed with quantitative ICG perfusion assessment (q-ICG). q-ICG was performed by extracting perfusion metrics from a time-intensity curve generated from an image analysis software: FMAX: maximal fluorescence intensity, TMAX: time until maximal fluorescent signal, T1/2MAX: time until half-maximal fluorescent signal, time ratio (T1/2MAX/TMAX) and slope.

Results

A total of 68 patients (33 ICA and 35 ECA) were available for analysis. Demographics were similar between the groups, except for mean arterial blood pressure at the time of ICG infusion, which was significantly lower in the ICA group. We found a significantly steeper slope in the ICA group compared to the ECA group (6.3 vs. 4.7 AU/sec, P = .048). There were no significant differences in FMAX, TMAX, T1/2MAX, and time ratio.

Conclusion

We found evidence of an improved intestinal perfusion following ICA compared with ECA. This finding may be related to patient outcomes and should be explored further in the future.

Trial registration.

ClinicalTrials.gov NCT03130166.

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Acknowledgements

We are indebted to the patients who participated in the trial. We thank the foundations that granted the financial support.

Funding

The study was funded by unrestricted grants provided by the Louis-Hansen Foundation, Jacob & Olga Madsen’s foundation, Trigon Foundation, Toyota Foundation, Dagmar Marshalls Foundation, Vissing Foundation, The Kjaer Foundation, and the Nyegaard Foundation. The funding sources had no role in the design and conduct of the study; data collection, analyses, and interpretation of data; the preparation, review, or approval of the manuscript; or the decision to submit for publication.

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Authors and Affiliations

  1. Department of Surgery, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Niclas Dohrn, Magnus Laursen, Frederik Bjerg Clausen, Henrik Loft Jakobsen, Jakob Lykke & Mads Falk Klein

  2. Center for Surgical Science, Zealand University Hospital - Koege, Lykkebækvej 1, 4600, Koege, Denmark

    Niclas Dohrn, Carolin Oppermann, Helin Yikilmaz, Faisal Khesrawi, Steffen Brisling, Jens Ravn Eriksen & Ismail Gögenur

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  1. Niclas Dohrn
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Contributions

The study conception and design were performed by Niclas Dohrn, Mads Falk Klein, and Ismail Gögenur. All authors contributed to material preparation, data collection and analysis. The first draft of the manuscript was written by Niclas Dohrn and all authors commented on the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Niclas Dohrn.

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Competing interests

Dr. Carolin Oppermann received an unrestricted research grant from PerfusionTech, Denmark, during the period this study was conducted

Conflict of interest

Dr. Niclas Dohrn, Dr. Helin Yikilmaz, Dr. Magnus Laursen, Dr. Faisal Khesrawi, Dr. Frederik Bjerg Clausen, Dr. Henrik Loft Jakobsen, Dr. Steffen Brisling, Dr. Jakob Lykke, Dr. Jens Ravn Eriksen, Dr. Mads Falk Klein and Prof. Ismail Gögenur have no conflicts of interest or financial ties to disclose. Dr. Carolin Oppermann received an unrestricted research grant from PerfusionTech, Denmark, during the conduction of this study.

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Dohrn, N., Oppermann, C., Yikilmaz, H. et al. The effect of intracorporeal versus extracorporeal anastomosis in robotic right colectomy on perianastomotic perfusion: a substudy to a multicenter RCT. Langenbecks Arch Surg 407, 3577–3586 (2022). https://doi.org/10.1007/s00423-022-02693-4

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