Abstract
BackgroundsThough better short-term outcomes were frequently reported, differences in specimen parameters and the rate of subsequent peritoneal recurrence between intracorporeal anastomosis (IA) and extracorporeal anastomoses (EA) for laparoscopic right hemicolectomy have not been analyzed. We aimed to compare the pathologic differences and oncological outcomes between these two approaches.MethodsWe retrospectively analyzed 217 consecutive patients who underwent laparoscopic right hemicolectomies from September 2016 to April 2018 and classified them into IA and EA groups, based on the approach used. Propensity score matching analysis was performed, after which 101 patients were included in each group with the patients matched for demographics, tumor stage, and localization.ResultsThe IA group had a longer operative time, shorter length of stay, shorter time to first flatus and tolerating a soft diet, and better pain scale scores at postoperative day 3. No inter-group differences in conversion, postoperative complication, mortality, or readmission rates were found. The IA group had a longer resected colon length (23.67 vs. 19.75 cm, p = 0.010) and nearest resected margin (7.51 vs. 5.40 cm, p = 0.010) for cancer near the hepatic flexure. There are comparable 3-year overall survival (87.7% vs. 89.6%, p = 0.604) and disease-free survival (75.0% vs. 75.7%, p = 0.842) between the IA and EA groups. The rate of peritoneal recurrence was similar between the two groups (5.9% vs. 7.9%, p = 0.580).ConclusionsThe overall survival, disease-free survival, and the rate of peritoneal recurrence were comparable between the IA and EA procedures. IA ensures better recovery and comparable complications to EA and achieved a more precise tumor excision; thus, IA can be considered a safe procedure for patients with right-sided colon lesions.
Highlights
A laparoscopy-assisted colectomy (LAC) is currently the standard management for benign or malignant colorectal lesions [1,2,3,4]
Only few studies have analyzed the differences in specimen parameters with most studies presenting a longer specimen length acquired by using intracorporeal anastomosis (IA) [8,9,10,11], and insufficient data are available regarding the resection length of tumor or the margin length according to different tumor locations, between IA and extracorporeal anastomosis (EA)
To survey whether peritoneal recurrence is increasing because of opening the intestinal tract during the IA procedure, we focused on the occurrence of peritoneal seeding during the follow-up
Summary
A laparoscopy-assisted colectomy (LAC) is currently the standard management for benign or malignant colorectal lesions [1,2,3,4]. For lesions located on the right side, TLC is limited because of the need for intracorporeal hand-sewing of the anastomosis, which is technically more difficult than extracorporeal procedures. Some advantages of IA are that it helps avoid traction of the bowel through the small laparotomy wound and achieves greater lymph node yields and specimen lengths [8, 9]. We hypothesize that another advantage of IA is its potential assistance in the precise excision of a tumor, which contributes to a better surgical margin. Comparable long-term oncologic outcomes between IA and EA have been reported [7, 12], the data are limited in disease-free status and cannot reflect the influence of local recurrence or distant metastasis distinctly
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
