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Minerva Surgery 2021 Aug 02

DOI: 10.23736/S2724-5691.21.08934-6


lingua: Inglese

Short-term outcomes after laparoscopic right hemicolectomy for colon cancer: intracorporeal versus extracorporeal anastomosis

Angelo ZAPPALÀ 1, Vincenzo G. PIAZZA 2, Riccardo SCHILLACI 1, Marco VACANTE 3 , Antonio BIONDI 3, Diego PIAZZA 1

1 Department of General Surgery, Santissimo Salvatore Paternò Hospital District, Paternò, Catania, Italy; 2 Surgical Oncology Unit, Department of Oncology, Garibaldi-Nesima Hospital, Catania, Italy; 3 Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy


BACKGROUND: The purpose of this study was to compare the short-term outcomes of laparoscopic right hemicolectomy between intracorporeal (IA) and extracorporeal (EA) anastomosis techniques.
METHODS: A retrospective chart review of 77 consecutive patients who underwent laparoscopic right hemicolectomy from January 2016 to June 2018 was performed. The intracorporeal group included 36 patients and the extracorporeal group 41 patients.
RESULTS: Patient demographics and disease-related characteristics were similar. Mean operative time was 152±38.3 minutes in IA vs. 148±34.8 minutes in EA (p = 0.664). IA was not associated with less overall postoperative complications and decreased rate of surgical site infections. There was no statistically significant difference in the incidence of postoperative leak, length of stay, mortality in both groups. There was no perioperative difference in median number of lymph node harvested. There was statistically significant difference in the length of larger incision [50 (50-70) mm in IA vs 80 (70-100) mm in EA; p<0.001], length of the specimen (323 ±52.7 mm in IA vs 295±64.7 mm in EA; p<0.05), free tumor margin (113.6±47.4 in IA vs 75.6±37.4 mm in EA; p<0.001). There was a statistically significant difference in IA in the less postoperative use of analgesics (p<0.032), and return of bowel function (p<0.021).
CONCLUSIONS: IA seems feasible and safe; it does not significantly affect the length of surgery, and it guarantees maintenance of radical oncological standards. Furthermore, IA significantly improves cosmesis and patient comfort postoperatively, reducing the rates of emesis, which leads to higher rates of early regular diet tolerance. Therefore, laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short-term outcomes.

KEY WORDS: Intracorporeal anastomosis; Laparoscopic right hemicolectomy; Colon cancer; Surgery

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