Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer

Lee, Kang Hong; Ho, J.; Akmal, Yasir; Nelson, Rebecca A.; Pigazzi, Alessio

doi:10.1007/s00464-012-2698-1

Cited by 78 publications

(70 citation statements)

References 18 publications

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“…Median operative time was almost identical between the two groups in our analysis. These findings are in line with a prior retrospective analysis by our group of a smaller sample [15]. The literature is hard to council on this endpoint.…”

Section: Discussionsupporting

confidence: 91%

“…Fabozzi's [20] retrospective analysis of 50 patients was the only recent analysis to find a significant decrease in the risk of anastomotic leak (P <0.05). This, however, was not replicated by any other retrospective analysis, all of which found no significant difference in the incidence of anastomotic leak between the two techniques [15,18,20]. Furthermore, a 2014 systematic review and meta-analysis of 484 patients undergoing laparoscopic right colectomy with 272 IA cases and 212 EA cases failed to show any difference in the rate of anastomotic leak (OR 0.98, 95 % CI 0.30-3.15) [21].…”

Section: Discussionmentioning

confidence: 90%

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Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

et al. 2015

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Background The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA). Results A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups. MethodsConclusions IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 90%

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

et al. 2015

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“…[1][2][3] Laparoscopy has the additional benefits of improved postoperative recovery, reduced analgesia requirements and shorter length of hospital stay. 2,[4][5][6] There is also evolving evidence for long-term benefits, including reduced bowel obstructions and ventral hernias. 4,[7][8][9] There is wide variation among laparoscopic colon resection techniques, including the approach for mobilization (medial-to-lateral v. lateral-to-medial) and the extent of intracorporeal vessel ligation, bowel division or anastamosis.…”

mentioning

confidence: 99%

Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes

Vergis

Steigerwald

Bhojani

et al. 2015

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“…IA, intracorporeal anastomosis; EA, extracorporeal anastomosis. which could be particularly difficult in the presence of thick and short mesentery [3][4][5]. The aforementioned advantages are potentially in favor of the application of IA in obese patients as reported by several authors [5,7,11].…”

Section: Discussionmentioning

confidence: 93%

“…Several papers and meta-analyses have been published so far stressing the feasibility and safety of IA with no adverse effect on complications, anastomotic leak, or reoperation rates [2][3][4][5][6][7][8][9][10][11]. Among the reported potential advantages of IA, there is a reduction of incision length, and conversion rate, and the need of bowel exteriorization is eliminated with possible risk of bowel torsion [3][4][5]. Currently, there are no data available in the literature specifically addressing this issue in selected cohorts of obese patients.…”

mentioning

confidence: 99%

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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Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer

Abstract: Compared with the extracorporeal anastomosis technique, intracorporeal ileocolic anastomosis produces comparable short- and long-term outcomes in laparoscopic right hemicolectomy for colon cancer.

Cited by 78 publications

References 18 publications

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes

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

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