Abstract
Although intracorporeal anastomosis has been demonstrated to be safe and effective after right colectomy, limited data are available about its efficacy after left colectomy for colon cancer located in splenic flexure. A multi-institutional audit was designed, including 92 patients who underwent laparoscopic left colectomy with intracorporeal anastomosis (IA) compared with 89 matched patients who underwent a laparoscopic left colectomy with extracorporeal anastomosis (EA). There was no significant difference in terms of age, sex, BMI, and ASA score between the two groups. Post-surgical history and stage of disease according to AJCC/UICC TNM were also similar. IA and EA groups demonstrated similar oncologic radicality in terms of the number of lymph nodes harvested (18.5 ± 9 vs. 17.5 ± 8.4; p = 0.48). Recovery after surgery was also better in patients who underwent IA, as confirmed by the shorter time to flatus in the IA group (2.6 ± 1.1 days vs. 3.4 ± 1.2 days; p < 0.001) and higher post-operative pain expressed in the mean VAS Scale in the EA group (1.7 ± 2.1 vs. 3.5 ± 1.6; p < 0.001). Laparoscopic left colectomy with intracorporeal anastomosis was associated with a lower rate of post-operative complications (OR 6.7, 95% CI 2.2–20; p = 0.001). However, when stratifying according to Clavien classification, the difference was consistently confirmed for less severe (class I and II) complications (OR 7.6, 95% CI 2.5–23, p = 0.001) but not for class III, IV, and V complications (OR 1.8, 95% CI 0.1–16.9; p = 0.59). Our results were consistent to hypothesize that a complete laparoscopic approach could be considered a safe method to perform laparoscopic left colectomy with the advantage of a guaranteed faster recovery after surgery. Further randomized clinical trials are needed to obtain a more definitive conclusion.
Similar content being viewed by others
References
Jiang J, Jiang K, Dai Y et al (2015) Laparoscopic versus open surgery for mid-low rectal cancer: a systematic review and meta-analysis on short- and long-term outcomes. J Gastrointest Surg 19(8):1497–1512. https://doi.org/10.1007/s11605-015-2857-5
Bonjer HJ, Hop WCJ, Nelson H et al (2007) Laparoscopically assisted versus open colectomy for colon cancer: a meta-analysis. Arch Surg 142(3):298–303. https://doi.org/10.1001/archsurg.142.3.298
Wilson MZ, Hollenbeak CS, Stewart DB (2014) Laparoscopic colectomy is associated with a lower incidence of postoperative complications than open colectomy: a propensity score-matched cohort analysis. Color Dis 16(5):382–389. https://doi.org/10.1111/codi.12537
Swaid F, Sroka G, Madi H, Shteinberg D, Somri M, Matter I (2016) Totally laparoscopic versus laparoscopic-assisted left colectomy for cancer: a retrospective review. Surg Endosc 30(6):2481–2488. https://doi.org/10.1007/s00464-015-4502-5
Zheng M-H, Feng B, Lu A-G et al (2005) Laparoscopic versus open right hemicolectomy with curative intent for colon carcinoma. World J Gastroenterol 11(3):323–326
Senagore AJ, Delaney CP, Brady KM, Fazio VW (2004) Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am Coll Surg 199(5):675–679. https://doi.org/10.1016/j.jamcollsurg.2004.06.021
Franklin ME, Gonzalez JJ, Miter DB et al (2004) Laparoscopic right hemicolectomy for cancer: 11-year experience. Rev Gastroenterol Mex 69(Suppl 1):65–72
Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242(1):83–91
Anania G (2012) A totally mini-invasive approach for colorectal laparoscopic surgery. World J Gastroenterol 18(29):3869. https://doi.org/10.3748/wjg.v18.i29.3869
Roscio F, Bertoglio C, De Luca A, Frattini P, Scandroglio I (2012) Totally laparoscopic versus laparoscopic assisted right colectomy for cancer. Int J Surg 10(6):290–295. https://doi.org/10.1016/j.ijsu.2012.04.020
Chaves JA, Idoate CP, Fons JB et al (2011) A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy. Cir Esp 89(1):24–30. https://doi.org/10.1016/j.ciresp.2010.10.003
Scatizzi M, Kröning KC, Borrelli A, Andan G, Lenzi E, Feroci F (2010) Extracorporeal versus intracorporeal anastomosis after laparoscopic right colectomy for cancer: a case–control study. World J Surg 34(12):2902–2908. https://doi.org/10.1007/s00268-010-0743-6
Fabozzi M, Allieta R, Brachet Contul R et al (2010) Comparison of short- and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case-control study. Surg Endosc 24(9):2085–2091. https://doi.org/10.1007/s00464-010-0902-8
Magistro C, Di Lernia S, Ferrari G et al (2013) Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center. Surg Endosc 27(7):2613–2618. https://doi.org/10.1007/s00464-013-2799-5
Milone M, Elmore U, Di Salvo E et al (2015) Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc 29(8):2314–2320. https://doi.org/10.1007/s00464-014-3950-7
Steffen C, Bokey EL, Chapuis PH (1987) Carcinoma of the splenic flexure. Dis Colon Rectum 30:872–874. https://doi.org/10.1007/BF02555427
Schlachta CM, Mamazza J, Seshandri PA, Cadeddu M, Gregoire R (2001) Poulin defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 44:217–222
Bennett CI, Stryker SI, Ferriera MR, Adams J, Beart RW Jr (1997) The learning curve for laparoscopic colorectal surgery: preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 132:41–44
Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P (2003) Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 46(10):1371–1378
Vignali A, Elmore U, Cossu A, Lemma M, Calì B, De Nardi P, Rosati R 2016 Enhanced recovery after surgery (ERAS) pathway versus traditional care in laparoscopic rectal resection. A single-center experience. Tech Coloproctol 8:559–66
Clavien PA, Barkun J, de O Ml, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: 5-year experience. Ann Surg 250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2
Rondelli F, Trastulli S, Avenia N et al (2012) Is laparoscopic right colectomy more effective than open resection? A meta-analysis of randomized and nonrandomized studies. Colorectal Dis 14(8):e447–e469. https://doi.org/10.1111/j.1463-1318.2012.03054.x
Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93(8):921–928. https://doi.org/10.1002/bjs.5430
Abraham NS, Byrne CM, Young JM, Solomon MJ (2007) Meta-analysis of non-randomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer. ANZ J Surg 77(7):508–516. https://doi.org/10.1111/j.1445-2197.2007.04141.x
Tinmouth J, Tomlinson G (2004) Laparoscopically assisted versus open colectomy for colon cancer. N Engl J Med 351(9):933–94-4. https://doi.org/10.1056/NEJM200408263510919
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726. https://doi.org/10.1016/S0140-6736(05)66545-2
Lacy AM, García-Valdecasas JC, Piqué JM et al (1995) Short-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer. Surg Endosc 9(10):1101–1105
Hazebroek EJ, Color Study Group 2002 COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16(6):949–953. https://doi.org/10.1007/s00464-001-8165-z
Levien DH, Gibbons S, Begos D, Byrne DW (1991) Survival after resection of carcinoma of the splenic flexure. Dis Colon Rectum 34(5):401–403
Nakagoe T, Sawai T, Tsuji T et al (2001) Surgical treatment and subsequent outcome of patients with carcinoma of the splenic flexure. Surg Today 31(3):204–209. https://doi.org/10.1007/s005950170169
Carlini M, Spoletini D, Castaldi F, Giovannini C, Passaro U (2016) Laparoscopic resection of splenic flexure tumors. Updat Surg 68(1):77–83. https://doi.org/10.1007/s13304-016-0357-0
Ceccarelli G, Biancafarina A, Patriti A et al (2010) Laparoscopic resection with intracorporeal anastomosis for colon carcinoma located in the splenic flexure. Surg Endosc 24(7):1784–1788. https://doi.org/10.1007/s00464-009-0853-0
Pisani Ceretti A, Maroni N, Sacchi M et al (2015) Laparoscopic colonic resection for splenic flexure cancer: our experience. BMC Gastroenterol 15(1):76. https://doi.org/10.1186/s12876-015-0301-7
Carnuccio P, Jimero J, Pares D (2014) Laparoscopic right colectomy: a systematic review and meta-analysis of observational studies comparing two types of anastomosis. Tech Coloproctol 18(1):5–12
DeSouza A, Domajnko B, Park J, Marecik S, Prasad L, Abcarian H (2011) Incisional hernia, midline versus low transverse incision: what is the ideal incision for specimen extraction and hand-assisted laparoscopy? Surg Endosc 25(4):1031–1036. https://doi.org/10.1007/s00464-010-1309-2
Kisielinski K, Conze J, Murken AH, Lenzen NN, Klinge U, Schumpelick V (2004) The Pfannenstiel or so called ‘‘bikini cut’’: still effective more than 100 years after first description. Hernia 8:177–181
Orcutt ST, Balentine CJ, Marshall CL et al (2012) Use of a Pfannenstiel incision in minimally invasive colorectal cancer surgery is associated with a lower risk of wound complications. Tech Coloproctol 16:127–132
Funding
Marco Milone, Pierluigi Angelini, Berardi G, Morena Burati, Francesco Corcione, Paolo Delrio, Ugo Elmore, Maria Lemma, Alfredo Mellano, Andrea Muratore, Ugo Pace, Daniela Rega, Riccardo Rosati, Ernesto Tartaglia, and Giovanni Domenico De Palma have no financial support to declare or financial ties to disclose.
Author information
Authors and Affiliations
Contributions
Milone M—conception, design, interpretation of the data and drafting of the article; Milone M, Elmore U, Angelini P, Mellano A, Pace U, Rega D, Tartaglia E, Lemma M, Berardi G, Burati M, Manigrasso M—acquisition, analysis and interpretation of the data; Muratore A, Rosati R, Delrio P, Corcione F, De Palma GD—interpretation of the data and critical revisions; De Palma GD—critical revisions and final approval.
Corresponding author
Ethics declarations
Disclosures
Marco Milone, Pierluigi Angelini, Berardi G, Morena Burati, Francesco Corcione, Paolo Delrio, Ugo Elmore, Maria Lemma, Alfredo Mellano, Andrea Muratore, Ugo Pace, Daniela Rega, Riccardo Rosati, Ernesto Tartaglia, and Giovanni Domenico De Palma have no conflict of interest to declare.
Rights and permissions
About this article
Cite this article
Milone, M., Angelini, P., Berardi, G. et al. Intracorporeal versus extracorporeal anastomosis after laparoscopic left colectomy for splenic flexure cancer: results from a multi-institutional audit on 181 consecutive patients. Surg Endosc 32, 3467–3473 (2018). https://doi.org/10.1007/s00464-018-6065-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-018-6065-8