Abstract
Purpose
To compare the postoperative short-term results of intracorporeal anastomosis (IA) using overlap anastomosis (OLA), with those of extracorporeal anastomosis (EA) using functional end-to-end anastomosis (FEEA) or hand-sewn anastomosis (HSA), after laparoscopic colectomy (LAC).
Methods
The subjects of this retrospective study were 208 patients with colon cancer who underwent OLA, FEEA, or HSA after LAC at our institution, between 2018 and 2021. The short-term results of the OLA group were compared with those of the FEEA and HSA groups, respectively, using a propensity score-matching method.
Results
The mean operative time for anastomosis was longer in the OLA group than in the FEEA and HSA groups (p < 0.0001). The mean blood loss volume was less in the OLA group than in the FEEA and HSA groups (p = 0.0344 and p = 0.0002, respectively). The mean skin incision size was smaller in the OLA group than in the FEEA and HSA groups (p < 0.0001 and p = 0.0031, respectively). None of the patients in the OLA group had surgical site infections. Three to five patients were required for the surgeon to plateau on the learning curve.
Conclusion
Although IA required more time than EA, the skills appeared to improve with experience and the short-term results were superior to those of EA.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00595-021-02375-6/MediaObjects/595_2021_2375_Fig1_HTML.png)
Similar content being viewed by others
References
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colon Cancer version 2. (2021). https://www.nccn.org/.
COLOR Study Group. A randomized clinical trial comparing laparoscopic and open resection for colon cancer. Dig Surg. 2000;17:617–22.
Lacy AM, GarcÃa-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.
Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, MRC CLASICC trial group, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.
Grams J, Tong W, Greenstein AJ, Salky B. Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc. 2010;24:1886–91.
Vergis AS, Steigerwald SN, Bhojani FD, Sullivan PA, Hardy KM. Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastamosis: a comparison of short-term outcomes. Can J Surg. 2015;58:63–8.
Milone M, Elmore U, Di Salvo E, Delrio P, Bucci L, Ferulano GP, et al. Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc. 2015;29:2314–20.
Lee KH, Ho J, Akmal Y, Nelson R, Pigazzi A. Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer. Surg Endosc. 2013;27:1986–90.
Shapiro R, Keler U, Segev L, Sarna S, Hatib K, Hazzan D. Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis. Surg Endosc. 2016;30:3823–9.
Hanna MH, Hwang GS, Phelan MJ, Bui TL, Carmichael JC, Mills SD, et al. Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis. Surg Endosc. 2016;30:3933–42.
Milone M, Angelini P, Berardi G, Burati M, Corcione F, Delrio P, et al. Intracorporeal versus extracorporeal anastomosis after laparoscopic left colectomy for splenic flexure cancer: results from a multi-institutional audit on 181 consecutive patients. Surg Endosc. 2018;32:3467–73.
Widmar M, Aggarwal P, Keskin M, Strombom PD, Patil S, Smith JJ, et al. Intracorporeal anastomoses in minimally invasive right colectomies are associated with fewer incisional hernias and shorter length of stay. Dis Colon Rectum. 2020;63:685–92.
Magistro C, Lernia SD, Ferrari G, Zullino A, Mazzola M, De Martini P, et al. Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center. Surg Endosc. 2013;27:2613–8.
Anania G, Agresta F, Artioli E, Rubino S, Resta G, Vettoretto N, et al. 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. Surg Endosc. 2020;34:4788–800.
Feroci F, Lenzi E, Garzi A, Vannucchi A, Cantafio S, Scatizzi M. Intracorporeal versus extracorporeal anastomosis after laparoscopic right hemicolectomy for cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2013;28:1177–86.
Wu Q, ** C, Hu T, Wei M, Wang Z. Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2017;27:348–57.
van Oostendorp S, Elfrink A, Borstlap W, Schoonmade L, Sietses C, Meijerink J, et al. Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc. 2017;31:64–77.
Milone M, Elmore U, Vignali A, Gennarelli N, Manigrasso M, Burati M, et al. Recovery after intracorporeal anastomosis in laparoscopic right hemicolectomy: a systematic review and meta-analysis. Langenbecks Arch Surg. 2018;403:1–10.
Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal Carcinoma. Third English Edition. Tokyo: Kanehara & Co., Ltd.; 2019.
Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Hoboken: Wiley-Black Well; 2016.
BerrÃos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Healthcare infection control practices advisory committee. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152:784–91.
Vignali A, Bissolati M, De Nardi P, Di Palo S, Staudacher C. Extracorporeal vs. intracorporeal ileocolic stapled anastomoses in laparoscopic right colectomy: an interim analysis of a randomized clinical trial. J Laparoendosc Adv Surg Tech A. 2016;26:343–8.
Mari GM, Crippa J, Costanzi ATM, Pellegrino R, Siracusa C, Berardi V, Maggioni D. Intracorporeal anastomosis reduces surgical stress response in laparoscopic right hemicolectomy: a prospective randomized trial. Surg Laparosc Endosc Percutan Tech. 2018;28:77–81.
Allaix ME, Degiuli M, Bonino MA, Arezzo A, Mistrangelo M, Passera R, et al. Intracorporeal or extracorporeal ileocolic anastomosis after laparoscopic right colectomy: a double-blinded randomized controlled trial. Ann Surg. 2019;270:762–7.
Bollo J, Turrado V, Rabal A, Carrillo E, Gich I, Martinez MC, et al. Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial). Br J Surg. 2020;107:364–72.
Creavin B, Balasubramanian I, Common M, McCarrick C, El Masry S, Carton E, et al. Intracorporeal vs extracorporeal anastomosis following neoplastic right hemicolectomy resection: a systematic review and meta-analysis of randomized control trials. Int J Colorectal Dis. 2021;36:645–56.
Roscio F, Bertoglio C, De Luca A, Frattini P, Scandroglio I. Totally laparoscopic versus laparoscopic assisted right colectomy for cancer. Int J Surg. 2012;10:290–5.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest to declare.
Ethical approval
Ethics approval was obtained from the Tochigi Cancer Center institutional review board (20-C004). Formal consent was not required for this retrospective study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (MP4 90841 kb)
Rights and permissions
About this article
Cite this article
Ozawa, H., Sakamoto, J., Nakanishi, H. et al. Short-term outcomes of intracorporeal versus extracorporeal anastomosis after laparoscopic colectomy: a propensity score-matched cohort study from a single institution. Surg Today 52, 616–623 (2022). https://doi.org/10.1007/s00595-021-02375-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-021-02375-6