Extra- and intracorporeal anastomosis in right hemicolectomy (observational cohort study)

AIM: to compare intracorporeal and extracorporeal anastomosis in right hemicolectomy in patients with CRC.

PATIENTS AND METHODS: observational cohort study included 296 patients with colorectal cancer who underwent elective right hemicolectomy with ileo-transversal anastomosis (2023-2024). Patients were divided into two groups: extracorporeal (ECA) and intracorporeal (ICA) The primary endpoint was the rate and severity of postoperative complications by Clavien-Dindo scale, while the secondary endpoints were the time of surgery and hospital stay, gastrointestinal tract recovery time, readmission and postoperative ventral hernia rate. All interventions were performed by surgeons, who are annually performing at least 30 procedures for CRC.

RESULTS: extracorporeal group included 226 (76.4%) patients, while 70 (23.6%) — intracorporeal one. The median time of surgery was found to be significantly shorter in the ECA group (185 [150; 223] min) compared to the intracorporeal anastomosis group (200 [185; 240] min) (p < 0.001). The incidence of postoperative morbidity according to the Clavien-Dindo classification did not differ between the groups. Intra-abdominal complications in the ICA group occured in 10% (n = 7/70) of patients, there were no cases of anastomotic leak in this group, while in the ECA group the incidence of intra-abdominal complications were 18.1% (n = 41/226) (p = 0.106), with anastomosis leak rate of 4.0% (n = 9/226). Infection of the surgical site was less in the ICA group — 5.7%, (n = 4/70), than in the ECA group — 15.9%, (n = 38/226) (p = 0.033). The recovery of bowel function was observed earlier in the ICA group: the first stool was observed on 3 [3; 4] days in the ECA group and 3 [2; 3] in the ICA group (p < 0.001); median of the first flatus were 2 [2; 2] and 2 [1; 2] days, respectively (p < 0.001). The length of stay for ICA was shorter than for ECA (5 [3; 6] days vs. 7 [6; 8], p < 0.001). A total of 158/296 (64.8%) patients were examined for incisional hernias. Incisional hernias were only diagnosed in the extracorporeal group, accounting for 54/128 (42.2%) cases. There were no hernias in the intracorporeal group — 0/30.

CONCLUSION: intracorporeal anastomosis in right hemicolectomy does not increase the risk of intra-abdominal complications and can be considered a safe alternative to extracorporeal anastomosis, which showed early bowel function recovery and reduction of the risk of wound infection and incisional abdominal hernia.

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