Skip to main content
SpringerLink
Log in

Mid-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

There is still insufficient discussion of the mid- to long-term safety of the intracorporeal anastomosis (IA) method of reconstruction after laparoscopic colectomy (LAC) for colon cancer. The present study clarified the postoperative mid-term results of IA based on recurrence and the incidence of incision hernia.

Methods

This single-institution observational retrospective study included 268 patients with colon cancer who underwent IA or extracorporeal anastomosis (EA) after LAC at our institution between 2018 and 2021. The mid-term results of the IA group were compared with those of the EA group using a propensity score matching method.

Results

The median follow-up periods were 36 and 25 months in the EA and IA groups, respectively (p < 0.0001). In this matched cohort study, the recurrence-free survival (RFS) rates were comparable between the IA and EA groups (each group, n = 72; 3-year RFS: IA, 92.1%; EA, 88.2%; hazard ratio, 0.78; 95% confidence interval, 0.25–2.40; p = 0.66). The cumulative incisional hernia rates were 9.8% and 9.9% (p = 0.99) for the IA and EA groups, respectively.

Conclusion

The safety of IA after LAC was demonstrated in this study, as IA after LAC showed good mid-term results, including with regard to the rates of recurrence and incisional hernia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.

    Article  PubMed  Google Scholar 

  2. Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.

    Article  Google Scholar 

  3. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, MRC CLASICC trial group, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.

    Article  PubMed  Google Scholar 

  4. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. COlon cancer laparoscopic or open resection study group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.

    Article  PubMed  Google Scholar 

  5. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Japan Clinical Oncology Group Colorectal Cancer Study Group, et al. Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan clinical oncology group study JCOG 0404. Ann Surg. 2014;260:23–30.

    Article  PubMed  Google Scholar 

  6. Grams J, Tong W, Greenstein AJ, Salky B. Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc. 2010;24:1886–91.

    Article  PubMed  Google Scholar 

  7. Magistro C, Lernia SD, Ferrari G, Zullino A, Mazzola M, De Martini P, et al. 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. 2013;27:2613–8.

    Article  PubMed  Google Scholar 

  8. Wu Q, Jin C, Hu T, Wei M, Wang Z. Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2017;27:348–57.

    Article  PubMed  Google Scholar 

  9. Mari GM, Crippa J, Costanzi ATM, Pellegrino R, Siracusa C, Berardi V, Maggioni D. Intracorporeal anastomosis reduces surgical stress response in laparoscopic right hemicolectomy: a prospective randomized trial. Surg Laparosc Endosc Percutan Tech. 2018;28:77–81.

    Article  PubMed  Google Scholar 

  10. Milone M, Elmore U, Vignali A, Gennarelli N, Manigrasso M, Burati M, et al. Recovery after intracorporeal anastomosis in laparoscopic right hemicolectomy: a systematic review and meta-analysis. Langenbecks Arch Surg. 2018;403:1–10.

    Article  PubMed  Google Scholar 

  11. Allaix ME, Degiuli M, Bonino MA, Arezzo A, Mistrangelo M, Passera R, et al. Intracorporeal or extracorporeal ileocolic anastomosis after laparoscopic right colectomy: a double-blinded randomized controlled trial. Ann Surg. 2019;270:762–7.

    Article  PubMed  Google Scholar 

  12. Creavin B, Balasubramanian I, Common M, McCarrick C, El Masry S, Carton E, et al. Intracorporeal vs extracorporeal anastomosis following neoplastic right hemicolectomy resection: a systematic review and meta-analysis of randomized control trials. Int J Colorectal Dis. 2021;36:645–56.

    Article  CAS  PubMed  Google Scholar 

  13. Bollo J, Turrado V, Rabal A, Carrillo E, Gich I, Martinez MC, et al. Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial). Br J Surg. 2020;107:364–72.

    Article  CAS  PubMed  Google Scholar 

  14. Ferrer-Márquez M, Rubio-Gil F, Torres-Fernández R, Moya-Forcén P, Belda-Lozano R, Arroyo-Sebastián A, et al. Intracorporeal versus extracorporeal anastomosis in patients undergoing laparoscopic right hemicolectomy: a multicenter randomized clinical trial (the IVEA-study). Surg Laparosc Endosc Percutan Tech. 2021;31:408–13.

    Article  Google Scholar 

  15. Małczak P, Wysocki M, Pisarska-Adamczyk M, Major P, Pędziwiatr M. Bowel function after laparoscopic right hemicolectomy: a randomized controlled trial comparing intracorporeal anastomosis and extracorporeal anastomosis. Surg Endosc. 2022;36:4977–82.

    Article  PubMed  Google Scholar 

  16. Ozawa H, Sakamoto J, Nakanishi H, Fujita S. Short-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution. Surg Today. 2022;52:616–23.

    Article  PubMed  Google Scholar 

  17. Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal Carcinoma. Third English Edition. 2019 Kanehara & Co., Ltd., Tokyo

  18. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Hoboken: Wiley-Black Well; 2016.

    Google Scholar 

  19. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Japanese Society for Cancer of the Colon and Rectum, et al. Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020;25:1–42.

    Article  PubMed  Google Scholar 

  20. Hanna MH, Hwang GS, Phelan MJ, Bui TL, Carmichael JC, Mills SD, et al. Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis. Surg Endosc. 2016;30:3933–42.

    Article  PubMed  Google Scholar 

  21. Lee KH, Ho J, Akmal Y, Nelson R, Pigazzi A. Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer. Surg Endosc. 2013;27:1986–90.

    Article  PubMed  Google Scholar 

  22. Liao CK, Chern YJ, Lin YC, Hsu YJ, Chiang JM, Tsai WS, et al. Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study. World J Surg Oncol. 2021;19:6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kobayashi S, Inoue Y, Fujita F, Ito S, Yamaguchi I, Nakayama M, et al. Extent of intraluminal exfoliated malignant cells during surgery for colon cancer: differences in cell abundance ratio between laparoscopic and open surgery. Asian J Endosc Surg. 2019;12:145–9.

    Article  PubMed  Google Scholar 

  24. Kayano H, Nomura E, Ueda Y, Kuramoto T, Machida T, Mukai M, et al. Short- and long-term outcomes of 2-step stapled intracorporeal versus extracorporeal anastomosis in laparoscopic colectomy for colon cancer. Anticancer Res. 2019;39:6393–401.

    Article  PubMed  Google Scholar 

  25. Ambe PC, Kankam J, Zarras K. Peritoneal spillage is not an issue in patients undergoing minimally invasive surgery for colorectal cancer. World J Surg Oncol. 2020;18:107.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kisielinski K, Conze J, Murken AH, Lenzen NN, Klinge U, Schumpelick V. The Pfannenstiel or so called “bikini cut”: still effective more than 100 years after first description. Hernia. 2004;8:177–81.

    Article  CAS  PubMed  Google Scholar 

  27. Shapiro R, Keler U, Segev L, Sarna S, Hatib K, Hazzan D. Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis. Surg Endosc. 2016;30:3823–9.

    Article  PubMed  Google Scholar 

  28. Widmar M, Aggarwal P, Keskin M, Strombom PD, Patil S, Smith JJ, et al. Intracorporeal anastomoses in minimally invasive right colectomies are associated with fewer incisional hernias and shorter length of stay. Dis Colon Rectum. 2020;63:685–92.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lee L, Abou-Khalil M, Liberman S, Boutros M, Fried GM, Feldman LS. Incidence of incisional hernia in the specimen extraction site for laparoscopic colorectal surgery: systematic review and meta-analysis. Surg Endosc. 2017;31:5083–93.

    Article  PubMed  Google Scholar 

  30. Choi HB, Chung D, Kim JS, Lee TH, Baek SJ, Kwak JM, et al. Midline incision vs. transverse incision for specimen extraction is not a significant risk factor for developing incisional hernia after minimally invasive colorectal surgery: multivariable analysis of a large cohort from a single tertiary center in Korea. Surg Endosc. 2022;36:1199–205.

    Article  PubMed  Google Scholar 

  31. Khor SN, Cheok SHX, Sultana R, Tan EKW. Incidence of incisional hernia after major colorectal cancer surgery & analysis of associated risk factors in Asian population: is laparoscopy any better? Asian J Surg. 2022;11:S1015-9584.

    Google Scholar 

  32. Vergis AS, Steigerwald SN, Bhojani FD, Sullivan PA, Hardy KM. Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes. Can J Surg. 2015;58:63–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kim Y, Kim KH, Seo KW, Lee SH, Son GM. Risk factors of incisional hernia after laparoscopic colorectal surgery with periumbilical minilaparotomy incision: a propensity score matching analysis. J Minim Invasive Surg. 2022;25:24–31.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Yamamoto M, Takakura Y, Ikeda S, Itamoto T, Urushihara T, Egi H. Visceral obesity is a significant risk factor for incisional hernia after laparoscopic colorectal surgery: a single-center review. Asian J Endosc Surg. 2018;11:373–7.

    Article  PubMed  Google Scholar 

  35. Hiraki M, Tanaka T, Azama S, Sadashima E, Sato H, Miyake S, et al. Risk factors of incisional hernia at the umbilical specimen extraction site in patients with laparoscopic colorectal cancer surgery. Ann Coloproctol. 2022. https://doi.org/10.3393/ac.2022.00213.0030. (Online ahead of print).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Editage (www.editage.com) for the English language editing.

Author information

Authors and Affiliations

  1. Department of Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan

    Heita Ozawa, Naoyuki Toyota, Junichi Sakamoto, Hiroki Nakanishi, Ryo Nakanishi & Shin Fujita

Authors
  1. Heita Ozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naoyuki Toyota
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junichi Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroki Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryo Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shin Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heita Ozawa.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

Ethical approval was obtained from the Tochigi Cancer Center Institutional Review Board (22-A002). Formal consent was not required for this retrospective study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ozawa, H., Toyota, N., Sakamoto, J. et al. Mid-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution. Surg Today 53, 992–1000 (2023). https://doi.org/10.1007/s00595-022-02636-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-022-02636-y

Keywords

Search

Navigation