Intracorporeal versus extracorporeal anastomosis for minimally invasive right colectomy: A multi-center propensity score-matched comparison of outcomes.

Robert K Cleary,Amir L Bastawrous,Mark K Soliman,Luca Giordano,Andrew Kassir,Daryl S Marx,Tobi J Reidy,Eduardo Parra-Davila,Darren Pollock,Joseph C Carmichael,Alessio Pigazzi,Vincent J Obias,Craig S Johnson,Daniel Steffens

doi:10.1371/journal.pone.0206277

Abstract

BackgroundThe primary objective of this study was to retrospectively compare short-term outcomes of intracorporeal versus extracorporeal anastomosis for minimally invasive laparoscopic and robotic-assisted right colectomies for benign and malignant disease. Recent studies suggest potential short-term outcomes advantages for the intracorporeal anastomosis technique.MethodsThis is a multicenter retrospective propensity score-matched comparison of intracorporeal and extracorporeal anastomosis techniques for laparoscopic and robotic-assisted right colectomy between January 11, 2010, and July 21, 2016.ResultsAfter propensity score-matching, there were a total of 1029 minimal invasive surgery cases for analysis—379 right colectomies (335 robotic-assisted and 44 laparoscopic) done with an intracorporeal anastomosis and 650 right colectomies (253 robotic-assisted and 397 laparoscopic) done with an extracorporeal anastomosis. There were no significant differences in any preoperative patient characteristics between groups. The minimally invasive intracorporeal anastomosis group had significantly longer operative times (p<0.0001), lower conversion to open rate (p = 0.01), shorter hospital length of stay (p = 0.02) and lower complication rate from after discharge to 30-days (p = 0.04) than the extracorporeal anastomosis group.ConclusionsThis comparison shows several clinical outcomes advantages for the intracorporeal anastomosis technique in minimally invasive right colectomy. These data may guide future refinements in minimally invasive training techniques and help surgeons choose among different minimally invasive options.

Highlights

Intracorporeal versus extracorporeal anastomosis for minimally invasive surgery the de-identified data collected by each site to a 3rd party statistician for statistical analysis
For minimally invasive surgery (MIS) right colectomy, the extracorporeal anastomosis is typically performed after delivering the specimen through a midline incision extraction site that may result in traction injury to the ileum and colon, and an increased rate of extraction site hernia.[16, 18,19,20]
The intracorporeal anastomosis technique is conducted after the specimen is completely detached from surrounding structures and allows the specimen to be removed from extraction site incisions less prone to incisional hernia.[15,16,17, 21,22,23,24,25]

Summary

Introduction

When considering MIS options, there may be clinical outcomes advantages to the intracorporeal approach when compared to the extracorporeal technique.[14,15,16,17] For MIS right colectomy, the extracorporeal anastomosis is typically performed after delivering the specimen through a midline incision extraction site that may result in traction injury to the ileum and colon, and an increased rate of extraction site hernia.[16, 18,19,20] In contrast, the intracorporeal anastomosis technique is conducted after the specimen is completely detached from surrounding structures and allows the specimen to be removed from extraction site incisions less prone to incisional hernia.[15,16,17, 21,22,23,24,25] The purpose of this multi-institutional retrospective study was to compare the short-term clinical outcomes of right colectomy MIS (laparoscopic or robotic-assisted) performed with intracorporeal versus extracorporeal anastomosis for benign and malignant disease. Recent studies suggest potential short-term outcomes advantages for the intracorporeal anastomosis technique

Objectives

Methods

Results