Intracorporeal versus Extracorporeal Anastomosis for Laparoscopic Right Hemicolectomy: Short-Term Outcomes

Laparoscopic right hemicolectomy represents an effective therapeutic approach for right colon cancer (RCC). The primary aim of this study was to evaluate bowel function recovery, length of hospital stay, operative time, and the number of general and anastomosis-related postoperative complications from intracorporeal anastomosis (ICA) vs. extracorporeal anastomosis (ECA); the secondary outcome was the number of lymph nodes retrieved. This observational study was conducted on 108 patients who underwent right hemicolectomy for RCC; after surgical resection, 64 patients underwent ICA and 44 underwent ECA. The operative time was slightly longer in the ICA group than in the ECA group, even though the difference was not significant (199.31 ± 48.90 min vs. 183.64 ± 35.80 min; p = 0.109). The length of hospital stay (7.53 ± 1.91 days vs. 8.77 ± 3.66 days; p = 0.036) and bowel function recovery (2.21 ± 1.01 days vs. 3.45 ± 1.82 days; p < 0.0001) were significantly lower in the ICA group. There were no significant differences in postoperative complications (12% in ICA group vs. 9% in ECA group), wound infection (6% in ICA group vs. 7% in ECA group), or anastomotic leakage (6% in ICA group vs. 9% in ECA group). We did not observe a significant difference between the two groups in the number of lymph nodes collected (19.46 ± 7.06 in ICA group vs. 22.68 ± 8.79 in ECA group; p = 0.086). ICA following laparoscopic right hemicolectomy, compared to ECA, could lead to a significant improvement in bowel function recovery and a reduction in the length of hospital stay in RCC patients.

Bowel function after laparoscopic right hemicolectomy: a randomized controlled trial comparing intracorporeal anastomosis and extracorporeal anastomosis

Background The laparoscopic right hemicolectomy is the standard surgical treatment for right-sided colon cancer. The continuity of the digestive tract is restored through ileocolic anastomosis which can be performed extracorporeally or intracorporeally. The study aimed to compare both anastomotic techniques in laparoscopic right hemicolectomy. Materials and methods A single-blinded two-armed randomized control trial with 1:1 parallel allocation carried out from 2016 to 2020 in a single center. The follow-up period was 30 days. Compared interventions involved extracorporeal and intracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy. The main outcome of the study was bowel recovery measured as the time to the first stool. Other outcomes involved the time to the first flatus, morbidity, and duration of surgery. Results One hundred and seventeen patients undergoing a laparoscopic right hemicolectomy with curative intent were eligible for the trial. Eight patients refused to participate. One hundred and two patients were analyzed, 52 in the intracorporeal group and 50 in the extracorporeal group. The groups did not differ in terms of cancer stage or body mass index, but did differ in age and sex. Intracorporeal anastomosis was associated with a shorter time to the first stool than extracorporeal, 32.8 h (26.0–43.7) vs. 41.7 (35.9–50.0), p = 0.017. There was no significant difference in the time to the first flatus, 30 h (23.2–42.3) vs. 26.6 h (21.8–37.3), p = 0.165. Similarly, overall complications did not differ (EC 12/50 vs. IC 10/52, p = 0.56). There were no differences in length of surgery, 190 min (150–230) and 190 min (180–220), p = 0.55. Conclusion Intracorporeal ileocolic anastomosis following laparoscopic right hemicolectomy results in slightly faster bowel recovery, with no differences in morbidity and duration of surgery.

EP.TH.770Upgrading the level of evidence regarding Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: Meta-analysis of randomised controlled trials

Objectives To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy. Methods We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Results We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P &lt; 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P &lt; 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups. Conclusions The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length. Future research may provide stronger evidence in favour of an intervention.

EP.FRI.265 Laparoscopic Right Hemicolectomy with Complete Mesocolic Excision for a T4 Caecal Tumour with Associated Phlegmon

A 67-years-old female presented with right lower abdominal pain and raised inflammatory markers. A computed tomography scan showed marked inflammatory changes with collections adjacent to terminal ileum. Patient was managed with intravenous antibiotics initially. Subsequent colonoscopy showed a bulky 8cm caecal pole tumour involving ileocaecal valve. Histopathology confirmed a diagnosis of moderately differentiated adenocarcinoma. Staging CT was negative for distant metastases. The patient subsequently proceeded to laparoscopic right hemicolectomy with complete mesocolic excision (CME). Intraoperatively the ileocolic vein was clipped just at the level of its confluence with superior mesenteric vein. The ileocolic artery was divided at its origin form superior mesenteric artery followed by division of right colic artery. The caecal mass was dissected off the abdominal wall. Proximally small bowel was resected 25cm form the ileocaecal valve and distally colon was divided up till mid transverse point. The specimen was extracted through a 9 cm Pfannenstiel incision. An intracorporeal isoperistaltic ileocolic side to side anastomosis was performed using a novel technique.1 The patient made full recovery and proceeded to adjuvant chemotherapy. Histology showed moderately differentiated T4 adenocarcinoma with tumour free lymph nodes. This case demonstrates intraoperative steps of laparoscopic complete mesocolic excision. CME is now becoming a standard due to improved oncological outcomes as it yields higher number of resected lymph nodes and better tumour clearance margins. This approach can be challenging due to variability in vascular anatomy, however, in experienced hands it is feasible and safe resulting in extensive lymphadenectomy and better oncological radicality. 1.https://www.ncbi.nlm.nih.gov/pubmed/28833963/

LongTerm Outcomes of Three-Port Laparoscopic Right Hemicolectomy Versus Five-Port Laparoscopic Right Hemicolectomy: A Retrospective Study

PurposeThe aim of this study is to compare the long-term outcomes of three-port laparoscopic right hemicolectomy (TPLRC) and five-port laparoscopic right hemicolectomy (FPLRC) with retrospective analysis.MethodsA total of 182 patients who accepted laparoscopic right hemicolectomy with either three ports (86 patients) or five ports (96 patients) from January 2012 to June 2017 were non-randomly selected and analyzed retrospectively.ResultsMore lymph nodes were harvested in the TPLRC group than in the FPLRC group [17.5 (7), 14 (8) ml, p &lt; 0.001]. There was less blood loss in the TPLRC group [50 (80) vs. 100 (125) ml, p = 0.015]. There were no significant differences in the other short-term or oncological outcomes between the two groups. The overall survival and disease-free survival were equivalent.ConclusionsTPLRC is recommendable as it guarantees short- and long-term equivalent outcomes compared with FPLRC.

98 Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: Meta-Analysis of Randomised Controlled Trials

Aim To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy. Method We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models. Results We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P &lt; 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P &lt; 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups. Conclusions The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length.