End-to-side versus side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer: Short-term outcomes of a randomized controlled trial.

Abstract

27 Background: A standard anastomotic configuration after right hemicolectomy is not well established, although short-term benefits of end-to-side anastomosis have been reported. This study was designed to assess the superiority of end-to-side anastomosis compared to side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer under an enhanced recovery program. Methods: Between September 2016 and August 2019, 130 patients (18–80 years) scheduled for laparoscopic right hemicolectomy were randomly assigned (1:1) to undergo end-to-side ( n = 65) or side-to-side ( n = 65) anastomosis. All patients underwent an enhanced recovery program with early diet and mobilization. The primary outcome was the cumulative recovery rate 7 days after surgery, defined as the percentage of patients who met all of the following recovery criteria: tolerated diet for 24h, analgesic-free, safe ambulation, and afebrile status without major complications. Results: The cumulative recovery rate did not differ between end-to-side (92.3%, 60/65) and side-to-side anastomosis (92.3%, 60/65) ( P = 1.000). Both approaches had similar cumulative recovery rates at 4, 5, and 6 days (end-to-side vs. side-to-side: 41.5% vs. 35.4%, P = 0.589; 73.8% vs. 63.1%, P = 0.257; 86.2% vs. 81.5%, P = 0.634; respectively) The median recovery time [interquartile range (IQR)] in the end-to-side and side-to-side groups was 105 [90-124] hours and 113 [84-139] hours, respectively ( P = 0.474), showing no significant difference. Length of stay [IQR] was similar in the end-to-side and side-to-side groups (5 [5–7] vs. 6 [5–7] days; P = 0.376). The 30-day complication rate (16.9% vs. 12.3%, P = 0.620), enhanced recovery program failure rate (10.8% vs. 7.7%, P = 0.763), and 30-day readmission rate (4.6% vs. 3.1%; P = 1.000) were not significantly different between the groups. Conclusions: This is the first randomized controlled trial showing that end-to-side anastomosis is not superior to side-to-side anastomosis in terms of short-term outcomes after laparoscopic right hemicolectomy. Clinical trial information: NCT02897531.