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

Cleary, Robert K.; Kassir, Andrew; Johnson, Craig S.; Bastawrous, Amir L.; Soliman, Magdi R.I.; Marx, Daryl S; Giordano, Luca; Reidy, Tobi; Parra-Dávila, Eduardo; Obias, Vincent; Carmichael, Joseph C.; Pollock, D.; Pigazzi, Alessio

doi:10.1371/journal.pone.0206277

Cited by 60 publications

(65 citation statements)

References 37 publications

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“…So far, the only clinical evidence is offered by retrospective low powered studies that indicate faster bowel movements, earlier re-feeding and shorter postoperative hospital stay after LRH with ICA. Prospective comparative multicenter studies comparing perioperative outcomes of ECA versus ICA are still missing [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27].…”

mentioning

confidence: 99%

Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Anania

Agresta²,

Artioli

et al. 2019

Surg Endosc

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Background While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons' attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients' characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration Clinical trial (Identifier: NCT03934151).While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of the right colon, there is still debate about how to perform the ileo-colic anastomosis [1][2][3][4].Over time, different types of ileo-colic anastomosis, such as stapled, hand-sewn and hybrid techniques, have been described and compared. Side-to-side ileo-colic anastomosis is the most frequently used technique by open surgery as well as by minimally invasive approach [5].Since the intra-corporeal ileo-colic anastomosis (ICA) technique has been proposed [6], the attention was focused on the comparison with the extra-corporeal option. Several cons of the extra-corporeal technique (ECA) have been

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confidence: 99%

Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Anania

Agresta²,

Artioli

et al. 2019

Surg Endosc

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“…In this review, only one study documented a significant increase in anastomotic leaks in patients undergoing laparoscopic ECA as opposed to robotic ICA . In addition, a propensity score matching study of robotic and laparoscopic formed anastomosis reported that minimally invasive ICA was associated with significantly shorter hospital stay and lower complication rates after discharge to 30 days than the ECA group . Similarly, this systematic review reports significantly lower hospital LOS in patients following RRH.…”

Section: Discussionmentioning

confidence: 74%

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

et al. 2019

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Aim Minimally invasive surgical approaches for cancer of the right colon have been well described with significant patient and equivalent oncological benefits. Robotic surgery has advanced in its ability to provide multi-quadrant abdominal access, leading the surgical community to widen its application outside of the pelvis to other abdominal compartments. Globally it is being realized that a patient's surgical episode of care is becoming the epicentre of cancer treatment. In order to establish the role of robotic surgery in a patient's episode of care, 'successful patient-oriented surgical' parameters in right hemicolectomy for malignancy were measured. The objective was to examine the rates of successful patient-oriented surgical outcomes in robotic right hemicolectomy (RRH) compared to laparoscopic right hemicolectomy (LRH) for cancer.Methods A systematic search of MEDLINE (Ovid: 1946-present), PubMed (NCBI), Embase (Ovid: 1966-present) and Cochrane Library was conducted using PRISMA for parameters of successful patient-oriented surgical outcomes in RRH and LRH for malignancy alone. The parameters measured included postoperative ileus, anastomotic complication, surgical wound infection, length of stay (LOS), incisional hernia rate, conversion to open, margin status, lymph node harvest and overall morbidity and mortality.Results There were 15 studies which included 831 RRH patients and 3241 LRH patients, with a median age of 62-74 years. No study analysed the concept of successful patient-oriented surgical outcomes. There was no significant difference in the incidence of postoperative ileus, with less time to first flatus in RRH (2.0-2.7 days, compared with 2.5-4.0 days, P < 0.05).Anastomotic leak rate in one study reported a significant increase in LRH compared to RRH (P < 0.05, 0% vs 8.3%). Significantly decreased LOS following RRH was outlined in six studies. One study reported a significantly higher rate of incisional hernias following LRH with extracorporeal anastomoses compared to RRH with intracorporeal anastomoses. Overall rates of conversion to open surgery were less with RRH (0%-3.9% vs 0%-18%, P < 0.001, 0.05). One study outlined significantly higher rates of incomplete resection with an open right hemicolectomy compared with minimally invasive laparoscopic and robotic resections, with positive margin rates of 2.3%, 0.9% and 0% respectively (P < 0.001). Two studies reported significantly higher lymph node harvest in RRH (P < 0.05). Overall morbidity and 30-day mortality were comparable in both approaches.Conclusion Thirty-day morbidity and mortality were comparable between the two approaches, with patients undergoing RRH having lower anastomotic complications, increased lymph node harvest, and reduced LOS, conversion to open and incisional hernia rates in a number of studies. There are limited data on surgical approach and impact on quality of life and what patients deem successful surgical outcomes. There is a further need for a randomized controlled trial examining successful patient-oriented outco...

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“…This is mainly attributed to the need for hand-sewing and knotting inside the abdominal cavity, and many surgeons required further training to perform intracorporeal sutures e ciently. The longer surgical time required to perform IA is also mentioned by several studies [5,8,11,12]; however, we predict that this may shorten with increased surgical experience and the establishment of a standard approach. Given that EA requires grasping of the colon and ileum for subsequent anastomosis, a trans-umbilical incision is usually chosen and the length of the wound is inevitably longer; however, using IA, any incision site can be selected for specimen retraction and the length of the wound can be shorter for grasping one longer specimen.…”

Section: Long-term Postoperative Outcomesmentioning

confidence: 72%

Is Increased Peritoneal Seeding a Drawback After Using Intracorporeal Anastomosis in Laparoscopic Right Colectomy? A Propensity Score-Matched Study

Liao

Chern

Lin

et al. 2020

Preprint

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Backgrounds: Though better short-term outcomes were frequently reported, differences in specimen parameters and the rate of subsequent peritoneal seeding 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.Methods: We 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.Results: The 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 IA and EA groups. The occurrence of peritoneal seeding was similar between the groups too.Conclusions: IA ensures better recovery and comparable complications to EA. The former also achieved a more precise tumor excision. It is a valid technique without compromising oncological outcomes.

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

Cited by 60 publications

References 37 publications

Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis

Successful patient‐oriented surgical outcomes in robotic vs laparoscopic right hemicolectomy for cancer – a systematic review

Is Increased Peritoneal Seeding a Drawback After Using Intracorporeal Anastomosis in Laparoscopic Right Colectomy? A Propensity Score-Matched Study

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