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Objective recovery time with end-to-side versus side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer: a randomized controlled trial

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Abstract

Background

Despite reports of the short-term benefits of end-to-side versus side-to-side anastomosis, we are aware of no prospective studies in which these methods were compared. We hypothesized the superiority of end-to-side over side-to-side anastomosis in terms of recovery after laparoscopic right hemicolectomy for colon cancer under an enhanced recovery program.

Methods

From September 2016 to August 2019, 130 patients were randomly allocated to receive end-to-side or side-to-side anastomosis at a single tertiary hospital in Korea. The primary outcome was the cumulative recovery rate seven days after surgery, defined as the percentage of patients who met all four recovery criteria: diet tolerance, no analgesia, safe ambulation, and an afebrile status. Student’s t test, the Mann–Whitney U test, the χ2 test, and Fisher’s exact test were used to compare variables, as applicable.

Results

The cumulative recovery rate at seven days did not differ between patients receiving end-to-side (92.3%, 60/65) or side-to-side anastomosis (92.3%, 60/65; P ≥ 0.999). The end-to-side and side-to-side groups had similar cumulative recovery rates at postoperative days 4, 5, and 6 (end-to-side vs. side-to-side: 41.5% vs 35.4%, P = 0.589; 73.8% vs 63.1%, P = 0.257; and 86.2% vs 81.5%, P = 0.634, respectively). None of the secondary endpoints differed for end-to-side vs. side-to-side anastomosis: the median length of postoperative hospitalization (5 [IQR 5–7] vs. 6 [IQR 5–7] days, respectively, P = 0.376), the 30-day complication rate (16.9% vs. 12.3%, respectively, P = 0.620), the enhanced recovery protocol failure rate (10.8% vs. 7.7%, respectively, P = 0.763), and the 30-day readmission rate (4.6% vs. 3.1%, respectively, P ≥ 0.999).

Conclusions

End-to-side anastomosis was not superior to side-to-side anastomosis in terms of recovery criteria after laparoscopic right hemicolectomy. These findings do not provide evidence for a functional advantage of end-to-side compared to side-to-side anastomosis.

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References

  1. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL (2004) Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 18:1163–1185

    Article  CAS  Google Scholar 

  2. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Group COcLoORS (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

    Article  Google Scholar 

  3. Colon Cancer Laparoscopic or Open Resection Study G, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52

    Article  Google Scholar 

  4. George WD (1991) Suturing or stapling in gastrointestinal surgery: a prospective randomized study. Br J Surg 78:337–341

    Article  Google Scholar 

  5. Neutzling CB, Lustosa SA, Proenca IM, Da Silva EM, Matos D (2012) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003144

    Article  PubMed  Google Scholar 

  6. Feng JS, Li JY, Yang Z, Mo CXY, JJ, Li SH, (2018) Stapled side-to-side anastomosis might be benefit in intestinal resection for Crohn’s disease: a systematic review and network meta-analysis. Medicine 97:e0315

    Article  Google Scholar 

  7. Goulder F (2012) Bowel anastomoses: the theory, the practice and the evidence base. World J Gastrointest Surg 4:208–213

    Article  Google Scholar 

  8. Puleo S, Sofia M, Trovato MA, Pesce A, Portale TR, Russello D, La Greca G (2013) Ileocolonic anastomosis: preferred techniques in 999 patients a multicentric study. Surg Today 43:1145–1149

    Article  Google Scholar 

  9. Lee KH, Lee SM, Oh HK, Lee SY, Ihn MH, Kim DW, Kang SB (2016) Comparison of anastomotic configuration after laparoscopic right hemicolectomy under enhanced recovery program: side-to-side versus end-to-side anastomosis. Surg Endosc 30:1952–1957

    Article  Google Scholar 

  10. Smith TK, Robertson WJ (1998) Synchronous movements of the longitudinal and circular muscle during peristalsis in the isolated guinea-pig distal colon. J Physiology 506:563–577

    Article  CAS  Google Scholar 

  11. Ikeda T, Kumashiro R, Oki E, Taketani K, Ando K, Aishima S, Akahoshi T, Morita M, Maehara Y (2015) Evaluation of techniques to prevent colorectal anastomotic leakage. J Surg Res 194:450–457

    Article  Google Scholar 

  12. Liu Z, Wang G, Yang M, Chen Y, Miao D, Muhammad S, Wang X (2014) Ileocolonic anastomosis after right hemicolectomy for colon cancer: functional end-to-end or end-to-side? World J Surg Oncol 12:306

    Article  Google Scholar 

  13. Lee TG, Kang SB, Kim DW, Hong S, Heo SC, Park KJ (2011) Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum 54:21–28

    Article  Google Scholar 

  14. West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30:1763–1769

    Article  Google Scholar 

  15. Lee SM, Kang SB, Jang JH, Park JS, Hong S, Lee TG, Ahn S (2013) Early rehabilitation versus conventional care after laparoscopic rectal surgery: a prospective, randomized, controlled trial. Surg Endosc 27:3902–3909

    Article  Google Scholar 

  16. Oh HK, Ihn MH, Son IT, Park JT, Lee J, Kim DW, Kang SB (2016) Factors associated with failure of enhanced recovery programs after laparoscopic colon cancer surgery: a single-center retrospective study. Surg Endosc 30:1086–1093

    Article  Google Scholar 

  17. Varadhan KK, Neal KR, Dejong CHC, Fearon KCH, Ljungqvist O, Lobo DN (2010) The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 29:434–440

    Article  Google Scholar 

  18. Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56:667–678

    Article  Google Scholar 

  19. Spanjersberg WR, Van Sambeeck JDP, Bremers A, Rosman C, van Laarhoven CJHM (2015) Systematic review and meta-analysis for laparoscopic versus open colon surgery with or without an ERAS programme. Surg Endosc 29:3443–3453

    Article  CAS  Google Scholar 

  20. Steichen FM (1968) The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses. Surgery 64:948–953

    CAS  PubMed  Google Scholar 

  21. Kano M, Hanari N, Gunji H, Hayano K, Hayashi H, Matsubara H (2017) Is “functional end-to-end anastomosis” really functional? A review of the literature on stapled anastomosis using linear staplers. Surg Today 47:1–7

    Article  Google Scholar 

  22. Mike M, Kano N (2015) Laparoscopic surgery for colon cancer: a review of the fascial composition of the abdominal cavity. Surg Today 45:129–139

    Article  Google Scholar 

  23. Umpleby HC, Williamson RC (1987) Anastomotic recurrence in large bowel cancer. Br J Surg 74:873–878

    Article  CAS  Google Scholar 

  24. Hasegawa J, Nishimura J, Yamamoto S, Yoshida Y, Iwase K, Kawano K, Nezu R (2011) Exfoliated malignant cells at the anastomosis site in colon cancer surgery: the impact of surgical bowel occlusion and intraluminal cleaning. Int J Colorectal Dis 26:875–880

    Article  Google Scholar 

  25. Ikehara K, Endo S, Kumamoto K, Hidaka E, Ishida F, Tanaka J, Kudo SE (2016) Positive detection of exfoliated colon cancer cells on linear stapler cartridges was associated with depth of tumor invasion and preoperative bowel preparation in colon cancer. World J Surg Oncol 14:233

    Article  Google Scholar 

  26. Offodile AC 2nd, Feingold DL, Nasar A, Whelan RL, Arnell TD (2010) High incidence of technical errors involving the EEA circular stapler: a single institution experience. J Am Coll Surg 210:331–335

    Article  Google Scholar 

  27. Allaix ME, Degiuli M, Bonino MA, Arezzo A, Mistrangelo M, Passera R, Morino M (2019) Intracorporeal or extracorporeal ileocolic anastomosis after laparoscopic right colectomy: a double-blinded randomized controlled trial. Ann Surg 270:762–767

    Article  Google Scholar 

  28. Bollo J, Turrado V, Rabal A, Carrillo E, Gich I, Martinez MC, Hernandez P, Targarona E (2019) Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial). Br J Surg 107:364–372

    Article  Google Scholar 

  29. Gianotti L, Sandini M, Romagnoli S, Carli F, Ljungqvist O (2020) Enhanced recovery programs in gastrointestinal surgery: actions to promote optimal perioperative nutritional and metabolic care. Clin Nutr 39:2014–2024

    Article  Google Scholar 

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Funding

This study was supported by Grant No. 14–2016-016 from the Seoul National University Bundang Hospital (SNUBH) Research Fund.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

    Min Hyun Kim, Sung Il Kang, Jung Rae Cho, Jeehye Lee, In Jun Yang, Jung Wook Suh, Heung-Kwon Oh, Duck-Woo Kim & Sung-Bum Kang

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  1. Min Hyun Kim
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Correspondence to Sung-Bum Kang.

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Disclosures

Drs. Min Hyun Kim, Sung Il Kang, Jung Rae Cho, Jeehye Lee, In Jun Yang, Jung Wook Suh, Heung-Kwon Oh, Duck-Woo Kim, and Sung-Bum Kang have no conflicts of interest or financial ties to disclose.

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Kim, M.H., Kang, S.I., Cho, J.R. et al. Objective recovery time with end-to-side versus side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer: a randomized controlled trial. Surg Endosc 36, 2499–2506 (2022). https://doi.org/10.1007/s00464-021-08536-5

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