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Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

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Abstract

Background

The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA).

Methods

A retrospective chart review of 195 consecutive patients who underwent laparoscopic right hemicolectomy by four colorectal surgeons at three institutions from March 2005 to June 2014 was performed. Multivariate regression analysis was used to compare postoperative and oncologic outcomes.

Results

A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups.

Conclusions

IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising outcomes.

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Acknowledgments

Dr. Hanna and Dr. Pigazzi had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Author contributions

All authors made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, drafting the article and revising it critically for important intellectual content and final approval of the version to be published.

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Correspondence to Mark H. Hanna.

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Disclosures

Dr. Stamos has had Ethicon, Olympus and Covidien training grant support paid to the University of California, Irvine, for clinical immersion courses for lap colectomy. He has also been a consultant and speaker for Ethicon, Olympus, Gore, NiTi/NovoGI and Novadaq. Pigazzi has been a consultant for Intuitive Surgical, Cook, Ethicon, Covidien, Cubist. Mills and Carmichael have had Ethicon educational grant paid to the Department of Surgery, University of California, Irvine. Mark H. Hanna, Grace S. Hwang, Michael J. Phelan and Thanh-Lan Bui have no conflicts of interest or financial ties to disclose.

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Hanna, M.H., Hwang, G.S., Phelan, M.J. et al. Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis. Surg Endosc 30, 3933–3942 (2016). https://doi.org/10.1007/s00464-015-4704-x

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  • DOI: https://doi.org/10.1007/s00464-015-4704-x

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