Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers

Milone, Marco; Elmore, Ugo; Salvo, Enrico Di; Delrio, Paolo; Bucci, Luigi; Ferulano, G. P.; Napolitano, Carmine; Angiolini, Maria Rachele; Bracale, Umberto; Clemente, Marco; D’Ambra, Michele; Luglio, Gaetano; Musella, Mario; Pace, Ugo; Rosati, Riccardo; Milone, Francesco

doi:10.1007/s00464-014-3950-7

Cited by 137 publications

(116 citation statements)

References 49 publications

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“…In the present series, although an earlier recovery of gas and bowel function was reported in the IA group, the 2 groups experienced a similar length of stay and incidence of postoperative ileus. These results are in line with the experience of the majority of authors who have analyzed the outcome of IA vs. EA in the nonobese population [4,5,14,15,25] and with our recent interim analysis of a Randomized Controlled Trial on the same subject [12]. In the aforementioned study, a similar length of stay was reported in the 2 groups, despite an earlier recovery of bowel function, and a lower incidence of postoperative ileus was observed in the IA.…”

Section: Discussionsupporting

confidence: 88%

“…Similar results were reported by 4 recent meta-analyses, comparing the 2 surgical techniques in the nonobese population [8][9][10][11][12]. This finding is most likely multifactorial [8][9][10][11][12]14]. The high surgical volume of the center, the completion of the learning curve for IA anastomosis before starting the present trial, the presence of a dedicated surgical team might be considered, since LPS right colectomy with IA emerged as one of the most difficult LPS colorectal procedures, suggesting for a longer learning curve [22].…”

Section: Discussionsupporting

confidence: 85%

“…Contrasting results have been reported with respect to conversion rates in the nonobese population when IA and EA outcomes following LPS right colectomy are analyzed. Similar [5,12] increased [13] or reduced [14][15][16][17] conversion rates for IA have been reported so far. In this study, patients in the EA group experienced a conversion rate of 17.1%, which is in range with the reported rates of others dealing with obese patients [17][18][19].…”

Section: Discussionsupporting

confidence: 78%

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Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Vignali¹,

Elmore²,

Lemma³

et al. 2017

Dig Surg

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Background/Aims: To compare short- and long-term outcomes of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) in obese (body mass index >30 kg/m²) patients. Patients and Methods: Sixty-four consecutive obese patients who underwent laparoscopic (LPS) right colectomy with IA were matched with 64 patients who underwent LPS right colectomy with EA. Intraoperative variables, short-term outcomes, readmission rates, and morbidity and mortality rates were analyzed along with long-term outcomes. Results: Conversion to open surgery occurred in 4 patients in the IA group and 11 patients in the EA group (p = 0.097). The overall 30-day morbidity rate was 29.6% in the IA and 32.8% in the EA (p = 0.70). No 30-day mortality occurred. Anastomotic leak occurred in 4.7% of patients in the IA group vs. 7.8% in the EA group (p = 0.71). In the IA group, an earlier recovery of bowel function was observed (p = 0.01). No differences were observed with respect to the length of stay and reoperation rate. No 30-day readmission occurred in the IA compared to 5 patients readmitted in the EA group (p = 0.058). A higher incidence of incisional hernia was observed in the EA group (p = 0.033). Conclusion: IA in obese patients is associated with similar short-term outcomes, lower incidence of incisional hernias, and might possibly reduce the risk of hospital readmission.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 78%

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Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Vignali¹,

Elmore²,

Lemma³

et al. 2017

Dig Surg

Self Cite

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“…In the complications of colon cancer surgery, anastomotic leakage after colon cancer surgery not only increased duration of hospital day and mortality rate, but also worsened the long-term oncological outcome (14). Typically, the percentage of anastomotic leakage in colon surgery has been reported to be below 8% (9,10,13,15,16). In this study, the incidence of anastomotic leakage was 2.2% for HS, 1.6% for FEEA and none for TRI, indicating a relatively low percentage when compared to past reports.…”

Section: Discussionmentioning

confidence: 99%

“…In laparoscopic surgery, intestinal anastomosis is frequently performed extracorporeally due to difficulty with intracorporeal anastomosis connected to technical reasons (15). However, a broader intestinal mobilization and dissection are required for extracorporeal anastomosis in laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Which Is the Safer Anastomotic Method for Colon Surgery? – Ten-year Results

Kosuge

Eto

Hashizume

et al. 2017

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Abstract. Background Several types of intestinal anastomoses following colonic resection have been devised in the past. While the types of intestinal anastomoses can be classified into hand-sewn (HS) and stapled anastomosis, the latter has been the mainstream in recent years due to simplicity and being less timeconsuming (1-3) of which functional end-to-end anastomosis (FEEA) has been used widely (4). This technique has been proven especially useful for intestinal anastomosis with discrepancy in diameter (5), with a number of studies reporting that FEEA is an easy and safe technique compared with the conventional HS procedure (6, 7). On the other hand, Venkatesh et al., in 1993, reported a stapled intestinal anastomosis called triangulating anastomosis (TRI) (8). For colon surgery, TRI is a simple end-to-end anastomosis and more physiological than FEEA for which only a few studies have been undertaken (9, 10). In colon surgery, there is no golden standard of anastomotic techniques, which is generally selected by surgeon's preferences or by local conditions. In this study, we retrospectively conducted a comparative analysis to report the outcome of colon resection to evaluate the safety of anastomotic techniques. Patients and MethodsPatients. From July 2003 to June 2013, 1,324 patients underwent colorectal surgery with primary intestinal reconstruction at the Jikei University Hospital, Tokyo, Japan. A retrospective comparative investigation was carried out to study the influence of the methods of intestinal anastomosis on anastomotic complications using the data from 684 cases, after exclusion of the following cases, some with multiple overlaps: emergency surgery (29 cases), rectal anastomosis (594 cases), use of a circular stapler (627 cases) and creation of a defunctioning stoma (113 cases). The patients were classified into three groups by the type of anastomosis as follows: HS (n=93), FEEA (n=255) and TRI (n=336) ( Table I). Methods of intestinal anastomoses were selected by the preference of each surgeon. The diagnosis of anastomotic leakage was defined based on imaging studies and clinical signs, such as fever >38.5˚C, leukocytosis, elevated serum C-reactive protein, drainage of intestinal content from the drain or computed tomography findings of abscess formation around the anastomosis. The diagnosis of anastomotic stricture was defined based on imaging studies demonstrating intestinal distension starting from oral side of the anastomotic site. Anastomotic bleeding was defined by melena or endoscopic findings within seven days after surgery.As patient's factors, we classified tumor locations into two groups: right-sided colon (cecum, ascending colon and right transverse colon) vs. left-sided colon (left transverse colon, descending colon and sigmoid colon).We investigated the relation between anastomotic complications (anastomotic leakage, stricture and bleeding) and clinical factors, such as age, gender, etiology (benign or malignant), location (right-sided colon or left-sided colon), anastomosis (ileo-co...

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Clinical outcome of laparoscopic vs open right hemicolectomy for colon cancer: A propensity score matching analysis of the Japanese National Clinical Database

Matsuda

Endo

Ito

et al. 2020

Annals of Gastroent Surgery

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Aim The advantages of laparoscopic right hemicolectomy over open surgery for colon cancer in general clinical practice are debated, as evidenced by the continued use of open surgery in a significant proportion of patients worldwide. This study aimed to assess and compare the clinical outcome of laparoscopic and open right hemicolectomy for colon cancer using data from the Japanese National Clinical Database. Methods A total of 72 299 patients who underwent laparoscopic (n = 46 084) and open (n = 26 215) right hemicolectomy for colon cancer between 2014 and 2018 were enrolled in this retrospective study. Short‐term outcome was compared between groups using propensity score matching analysis. Results The incidence of overall postoperative morbidity ≥ Clavien‐Dindo classification grade 3 was significantly higher in the open surgery group than the laparoscopic group (4.7% vs 3.2%, P < .001). The incidence of most individual morbidities, including surgical site infection, anastomotic leakage, and ileus, was higher in the open surgery group. Short‐term outcomes, including intraoperative blood loss, postoperative hospital stay, reoperation rate, 30‐day mortality, and in‐hospital mortality, were superior in the laparoscopic group, except for operative time. Subgroup analyses showed that the incidence of postoperative morbidity was lower in the laparoscopic group for all prespecified subgroups. Conclusion Laparoscopic right hemicolectomy has an advantage over open surgery for colon cancer with respect to short‐term outcome.

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Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers

Abstract: Our results are encouraging to consider the intracorporeally approach the better way to fashion the anastomosis after laparoscopic right colectomy. This study clearly provides the rationale for a randomized clinical trial, which would be useful to give definitive conclusion.

Cited by 137 publications

References 49 publications

Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study

Which Is the Safer Anastomotic Method for Colon Surgery? – Ten-year Results

Clinical outcome of laparoscopic vs open right hemicolectomy for colon cancer: A propensity score matching analysis of the Japanese National Clinical Database

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