Intracorporeal anastomosis versus extracorporeal anastomosis following laparoscopic right hemicolectomy: Surgical outcomes of a single-center observational study

Abstract

Abstract Background The Enhanced Recovery After Surgery protocol strongly recommends minimally invasive approach to colon cancer for rapid recovery, lower complication rate, and wound-related complications. Intracorporeal anastomosis (ICA) is believed to offer better patient outcome compared with extracorporeal anastomosis (ECA). Materials and Methods From January 2021 to January 2022, a prospective observational study comparing ICA with ECA in patients after elective right hemicolectomy at a local surgical hospital was conducted. We included all patients ≥18 years old who underwent elective right hemicolectomy. Primary outcome was difference in the incidence of surgical site infection and anastomotic leakage postoperatively. Results Seventy-one patients had ICA with a mean age of 52 ± 9.8 years, whereas 67 patients had ECA with a mean age 54.2 ± 8.7 years. Mean overall operative time was longer after ICA (169.1 ± 35.7 minutes) compared with the ECA group (147 ± 36.9 minutes), P = 0.0001. Difference in estimated blood loss ( P = 0.60), tumor size ( P = 0.57), number of excised lymph nodes ( P = 0.19), stage ( P = 0.66), and pathology of specimen ( P = 0.53) between ICA and ECA was nonsignificant. Patients with ICA after right hemicolectomy had a quicker recovery of bowel function and time to pass stool (ICA: 3.74 ± 0.6 days vs ECA: 4 ± 0.5 days, P = 0.009), early commencement of oral intake (ICA: 2.6 ± 1.1 days vs ECA days: 3.6 ± 1.1, P = 0.0001), and fewer days in hospital (ICA: 4.8 ± 1.1 vs ECA: 6.2 ± 1.4, P = 0.0001) compared with patients with ECA, respectively. There were no significant differences in postoperative complications and causes of readmission between the two groups. Conclusions ICA offers comparable postoperative complications to ECA but has enhanced patient outcomes in terms of recovery.