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Intracorporeal Anastomosis Versus Extracorporeal Anastomosis in Laparoscopic Right Colectomy: An Observational Cohort Study

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Abstract

Background

Current studies did not draw definitive conclusions on comparison of intracorporeal anastomosis (ICA) with extracorporeal anastomosis (ECA) in laparoscopic right colectomy. Whether the intraperitoneal contamination induced by ICA can result in higher risk of postoperative abdominal infection remains unclear. This study was aimed to compare the short-term outcomes, especially the risk of abdominal infection after ICA versus ECA.

Methods

This was an observational cohort study as a secondary analysis of a randomized controlled trial (RCT)—RELARC trial (NCT02619942). The patients enrolled in the RELARC trial were diagnosed with primary colon adenocarcinoma without distant metastasis and underwent radical laparoscopic right colectomy between Jan 2016 and Dec 2019. In our study the patients who converted to open surgery in RELARC trial were excluded. The short-term outcomes were compared between ICA and ECA. The primary endpoint was abdominal infection. The inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) was used for adjusting the potential confounders.

Results

This study enrolled 975 patients with 119 patients undergoing ICA and 856 patients undergoing ECA. The incidence of abdominal infection was higher in ICA group (9.2% versus 1.5%, RR from IPTW = 5.7 (95%CI: 2.6–12.6), P < 0.001) as well as the incidence of wound infection (14.3% vs 3.3%, RR from IPTW = 5.0 (95%CI: 2.9–8.6), P < 0.001). ICA was associated with higher incidence of Clavien–Dindo (CD) grade I and II complications (CD-I: 15.1% versus 6.8%, RR from IPTW = 2.4 (95%CI: 1.5–3.9), P < 0.001; CD-II: 26.9% versus 8.2%, RR from IPTW = 3.6 (95%CI: 2.5–5.1), P < 0.001) but similar incidence of CD-III ~ IV complications compared to ECA (3.4% vs 2.1%, RR from IPTW = 1.2 (95%CI: 0.4–4.0), P = 0.73). In ICA group, choosing another incision rather than lengthening main port site decreased the incidence of wound infection although without statistical significance (17.3% (14/81) versus 7.9% (3/38), crude RR = 2.2 (95%CI: 0.7–7.2), P = 0.17).

Conclusion

ICA is likely to be associated with higher risk of abdominal infection and CD-I ~ II complications.

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Acknowledgements

The authors acknowledge Dr. Hao Zhao for statistical analysis in R. RELARC Study Group: Lai Xu, **angqian Su, **angqian He, **angqian Zhang, **angqian Lu, Lei Chen, Guannan Zhang, Bo Feng, Lu Zang, Junjun Ma, Yueming Sun, Yifei Feng, Dongjian Ji, **aohui Du, Changzheng He, Ze Fu, Pan Chi, Ying Huang, Weizhong Jiang, Ziqiang Wang, Qingbin Wu, Ming Zhong, Minhao Yu, Aiwen Wu, Pengju Chen, Anlong Zhu, Wenlong Guan, Bin Wu, Fei Li, Ang Li, Jianmin Xu, Guodong He, Liang Kang, **aowen He, Jian Suo, Daguang Wang, Haijun Deng, Yanan Wang, Yingjiang Ye, Kai Shen, Guole Lin, Hongwei Yao, Huizhong Qiu, Kefeng Ding, Tao Xu, Zhiyong Liang, Weixun Zhou, Huadan Xue, Bin Li, Zhongtao Zhang, Minhua Zheng, Yi **ao.

Funding

Funding for the study was provided by the Capital Characteristic Clinical Project of Bei**g Municipal Science & Technology Commission (Z161100000516014), the Non-profit Central Research Institute Fund of the Chinese Academy of Medical Sciences (2019XK320003) and National Natural Science Foundation of China (Project No. 62172437).

Author information

Author notes

  1. Rui Sun, Yuelun Zhang, and Bo Feng contributed equally to the work.

Authors and Affiliations

  1. Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Bei**g, China

    Rui Sun, Lai Xu, Junyang Lu, Guannan Zhang, Yi **ao, Haijun Deng & Huizhong Qiu

  2. Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Bei**g, China

    Yuelun Zhang

  3. Department of General Surgery, Rui** Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Bo Feng & Minhua Zheng

  4. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Bei**g, China

    **angqian Su

  5. Department of Colorectal Surgery, The First Affiliated Hospital of Nan**g Medical University, Nan**g, Jiangsu Province, China

    Yueming Sun

  6. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Unit III & Ostomy Service, Gastrointestinal Cancer Centre, Peking University Cancer Hospital & Institute, Bei**g, China

    Aiwen Wu

  7. Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China

    Liang Kang

  8. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China

    Haijun Deng

  9. Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China

    Pan Chi

  10. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Ming Zhong

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  1. Rui Sun
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Consortia

On behalf of the RELARC Study Group

  • Lai Xu
  • , **angqian Su
  • , **angqian He
  • , **angqian Zhang
  • , **angqian Lu
  • , Lei Chen
  • , Guannan Zhang
  • , Bo Feng
  • , Lu Zang
  • , Junjun Ma
  • , Yueming Sun
  • , Yifei Feng
  • , Dongjian Ji
  • , **aohui Du
  • , Changzheng He
  • , Ze Fu
  • , Pan Chi
  • , Ying Huang
  • , Weizhong Jiang
  • , Ziqiang Wang
  • , Qingbin Wu
  • , Ming Zhong
  • , Minhao Yu
  • , Aiwen Wu
  • , Pengju Chen
  • , Anlong Zhu
  • , Wenlong Guan
  • , Bin Wu
  • , Fei Li
  • , Ang Li
  • , Jianmin Xu
  • , Guodong He
  • , Liang Kang
  • , **aowen He
  • , Jian Suo
  • , Daguang Wang
  • , Haijun Deng
  • , Yanan Wang
  • , Yingjiang Ye
  • , Kai Shen
  • , Guole Lin
  • , Hongwei Yao
  • , Huizhong Qiu
  • , Kefeng Ding
  • , Tao Xu
  • , Zhiyong Liang
  • , Weixun Zhou
  • , Huadan Xue
  • , Bin Li
  • , Zhongtao Zhang
  • , Minhua Zheng
  •  & Yi **ao

Corresponding authors

Correspondence to Minhua Zheng or Yi **ao.

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Conflict of interest

There is no personal conflicts of interest or financial conflicts of interest of any of the authors.

Ethics approval

This research was performed as a sub-study of RELARC trial (NCT02619942). The RELARC study protocol and all amendments were approved by the Ethics Committee of Peking Union Medical College Hospital. Patient consent was acquired before enrollment.

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Appendix

Appendix

The packages used in R included MatchIt, reportReg, tableone, survey, reshape2, ggplot2, foreign, survival, survminer, table1, riskRegression, epiR, epitools, pwr, Rcpp, base and ComparisonSurv.

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Sun, R., Zhang, Y., Feng, B. et al. Intracorporeal Anastomosis Versus Extracorporeal Anastomosis in Laparoscopic Right Colectomy: An Observational Cohort Study. World J Surg 47, 785–795 (2023). https://doi.org/10.1007/s00268-022-06834-0

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