Comparative Analysis of Functional End-to-End and End-to-Side Anastomosis in Laparoscopic Right Hemicolectomy for Colon Cancer

Abstract

Purpose: Despite advancements in laparoscopic right hemicolectomy for right-sided colon cancer, the choice between functional end-to-end anastomosis (FETE) and end-to-side anastomosis (ETS) remains a topic of debate. This study aimed to compare these two techniques in terms of postoperative complications and disease-free survival. Methods: This retrospective analysis included 1202 patients who underwent laparoscopic right hemicolectomy for non-metastatic colon cancer at Samsung Medical Center between January 2007 and February 2016. The patients were divided into FETE (n = 968) and ETS (n = 234) groups based on the anastomosis technique used. Patients’ characteristics, oncologic results, operative outcomes, and postoperative complications were analyzed. Results: The baseline characteristics were similar between the two groups, except for a higher incidence of cancer obstruction in the ETS group (p < 0.001). No significant differences were observed in operation time, blood loss, length of hospital stay, time to the first meal, or time to first flatus. Anastomotic leakage rates were comparable (FETE 0.7% vs. ETS 0.4%, p = 0.999). The FETE group had a higher rate of postoperative ileus (4.4% vs. 1.3%, p = 0.022). Multivariable analysis indicated age, sex, and anastomosis type as significant predictors of postoperative ileus. Conclusion: The study findings demonstrate that both FETE and ETS anastomosis techniques in laparoscopic right hemicolectomy are comparable in terms of operation metrics and disease-free survival. However, FETE is associated with a higher incidence of postoperative ileus. These findings can guide surgical decision-making in the treatment of right-sided colon cancer.