A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy

Información del artículo

Abstract

Introduction

There is still insufficient scientific evidence on which is the best technique to perform the anastomosis -intracorporeal (IC) or extracorporeal (EC)- in right laparoscopic hemicolectomy. The objective of the present study is to determine whether there are differences to compare in both techniques.

Material and methods

A study was performed on a prospective patient series subjected to right laparoscopic hemicolectomy in our Hospital. The preoperative and the postoperative variables associated with complications recorded depending on the type of anastomosis.

Results

A total of 60 patients were intervened form June 2004 to June 2010 (35 IC; 25 EC). There were no significant differences between both groups as regards baseline preoperative characteristics or associated comorbidities. The median operation time was 212 minutes (142–305min), with no significant difference between both techniques. The number of lymph nodes removed was higher in the IC group (21 vs 14; P=.03). The beginning of oral tolerance and the first bowel movement were significantly earlier in the IC group. The complications rate was similar for both groups (14% IC; 16% EC; P=.89). Three patients in the IC group had anastomosis dehiscence. The mortality rate was 2.8% (one patient in each group)

Conclusion

Intracorporeal versus extracorporeal anastomosis in right laparoscopic hemicolectomy can obtain a higher number of resected lymph nodes and an earlier oral tolerance and intestinal transit.

Keywords:

Colorectal surgery

Right laparoscopic

hemicolectomy

Intracorporeal anastomosis

Resumen

Introducción

En la actualidad no existe suficiente evidencia científica sobre cuál es la mejor técnica para realizar la anastomosis −intracorpórea (IC) o extracorpórea (EC)− en la hemicolectomía derecha laparoscópica. El objetivo del presente estudio es determinar si existen diferencias al comparar ambas técnicas.

Material y métodos

Se realiza un estudio sobre una serie prospectiva de pacientes intervenidos en nuestro Centro mediante hemicolectomía derecha laparoscópica. Se comparan las variables preoperatorias, intraoperatorias y relacionadas con complicaciones recogidas en función del tipo de anastomosis.

Resultados

Desde junio de 2004 hasta junio de 2010 se intervinieron 60 pacientes (35 IC; 25 EC). No existieron diferencias significativas entre ambos grupos en cuanto a características basales preoperatorias ni comorbilidades asociadas. La mediana de tiempo operatorio fue de 212 minutos (142-305 min), sin diferencias significativas entre ambas técnicas. El número de ganglios extraídos resultó mayor en el grupo IC (21 versus 14; p=0,03). Tanto el inicio de la tolerancia oral como la primera deposición resultaron significativamente más precoces en el grupo IC. La tasa de complicaciones postoperatorias fue similar para ambos grupos (14% IC; 16% EC; p=0,89). Tres pacientes presentaron dehiscencia de anastomosis en las IC. La tasa de mortalidad fue del 2,8% (un paciente en cada grupo).

Conclusión

La anastomosis intracorpórea frente a la extracorpórea en la hemicolectomía derecha laparoscópica permite obtener un mayor número de ganglios resecados y un inicio más precoz de la tolerancia oral y del tránsito intestinal.

Palabras clave:

Cirugía colorrectal

Hemicolectomía derecha

laparoscópica

Anastomosis intracorpórea

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References

[1.]

J. Grams, W. Tong, A.J. Greenstein, B. Salky.

Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy.

Surg Endosc, 24 (2010), pp. 1886-1891

http://dx.doi.org/10.1007/s00464-009-0865-9 | Medline

[2.]

J.A. Kemp, S.R. Finlayson.

Outcomes of laparoscopic and open colectomy: a national population-based comparison.

Surg Innov, 15 (2008), pp. 277-283

http://dx.doi.org/10.1177/1553350608327171 | Medline

[3.]

C.P. Delaney, E. Chang, A.J. Senagore, M. Broder.

Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database.

Ann Surg, 247 (2008), pp. 819-824

http://dx.doi.org/10.1097/SLA.0b013e31816d950e | Medline

[4.]

K.Y. Bilimoria, D.J. Bentrem, H. Nelson, S.J. Stryker, A.K. Stewart, N.J. Soper, et al.

Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States.

Arch Surg, 143 (2008), pp. 832-839

http://dx.doi.org/10.1001/archsurg.143.9.832 | Medline

[5.]

G.D. Kennedy, C. Heise, V. Rajamanickam, B. Harms, E.F. Foley.

Laparoscopy decreases postoperative complication rates after abdominal colectomy: results from the national surgical quality improvement program.

Ann Surg, 249 (2009), pp. 596-601

http://dx.doi.org/10.1097/SLA.0b013e31819ec903 | Medline

[6.]

A.M. Lacy, J.C. Garcia-Valdecasas, S. Delgado, A. Castells, P. Taura, J.M. Pique, et al.

Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial.

Lancet, 359 (2002), pp. 2224-2229

http://dx.doi.org/10.1016/S0140-6736(02)09290-5 | Medline

[7.]

H. Nelson, The Clinical Outcomes of Surgical Therapy Study Group, et al.

A comparison of laparoscopically assisted and open colectomy for colon cancer.

N Engl J Med., 350 (2004), pp. 2050-2059

http://dx.doi.org/10.1056/NEJMoa032651 | Medline

[8.]

P.J. Guillou, P. Quirke, H. Thorpe, J. Walker, D.G. Jayne, A.M. Smith, et al.

Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial.

Lancet, 365 (2005), pp. 1718-1726

http://dx.doi.org/10.1016/S0140-6736(05)66545-2 | Medline

[9.]

D.K. Tong, J.K. Fan, W.L. Law.

Outcome of laparoscopic colorectal resection.

Surgeon, 6 (2008), pp. 357-360

Medline

[10.]

M. Buunen, R. Veldkamp, W.C. Hop, E. Kuhry, J. Jeekel, E. Haglind, et al.

Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial.

Lancet Oncol, 10 (2009), pp. 44-52

http://dx.doi.org/10.1016/S1470-2045(08)70310-3 | Medline

[11.]

H.J. Bonjer, W.C. Hop, H. Nelson, D.J. Sargent, A.M. Lacy, A. Castells, et al.

Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis.

Arch Surg, 142 (2007), pp. 298-303

http://dx.doi.org/10.1001/archsurg.142.3.298 | Medline

[12.]

R. Veldkamp, E. Kuhry, W.C. Hop, J. Jeekel, G. Kazemier, H.J. Bonjer, et al.

Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial.

Lancet Oncol, 6 (2005), pp. 477-484

http://dx.doi.org/10.1016/S1470-2045(05)70221-7 | Medline

[13.]

K.L. Leung, S.P. Kwok, S.C. Lam, J.F. Lee, R.Y. Yiu, S.S. Ng, et al.

Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial.

Lancet, 363 (2004), pp. 1187-1192

http://dx.doi.org/10.1016/S0140-6736(04)15947-3 | Medline

[14.]

M.M. Reza, J.A. Blasco, E. Andradas, R. Cantero, J. Mayol.

Systematic review of laparoscopic versus open surgery for colorectal cancer.

Br J Surg, 93 (2006), pp. 921-928

http://dx.doi.org/10.1002/bjs.5430 | Medline

[15.]

E. Kuhry, W.F. Schwenk, R. Gaupset, U. Romild, H.J. Bonjer.

Long-term results of laparoscopic colorectal cancer resection.

Cochrane Database Syst Rev, (2008), pp. CD003432

[16.]

M. Fabozzi, R. Allieta, R.B. Contul, M. Grivon, P. Millo, E. Lale-Murix, et al.

Comparison of short- and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case-control study.

Surg Endosc, 24 (2010), pp. 2085-2091

http://dx.doi.org/10.1007/s00464-010-0902-8 | Medline

[17.]

F.R. Jamali, A.M. Soweid, H. Dimassi, C. Bailey, J. Leroy, J. Marescaux.

Evaluating the degree of difficulty of laparoscopic colorectal surgery.

Arch Surg, 143 (2008), pp. 762-767

http://dx.doi.org/10.1001/archsurg.143.8.762 | Medline

[18.]

M.A. Bernstein, J.W. Dawson, P. Reissman, E.G. Weiss, J.J. Nogueras, S.D. Wexner.

Is complete laparoscopic colectomy superior to laparoscopic assisted colectomy?.

Am Surg, 62 (1996), pp. 507-511

Medline

[19.]

M. Hellan, C. Anderson, A. Pigazzi.

Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy.

JSLS, 13 (2009), pp. 312-317

Medline

[20.]

M.E. Franklin, J.J. Gonzalez, D.B. Miter, J.H. Mansur, J.M. Trevino, J.L. Glass, et al.

Laparoscopic right hemicolectomy for cancer: 11-year experience.

Rev Gastroenterol Mex, 69 (2004), pp. 65-72

Medline

[21.]

R. Bergamaschi, E. Schochet, C. Haughn, M. Burke, 3rd.J.F. Reed, J.P. Arnaud.

Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients.

Dis Colon Rectum, 51 (2008), pp. 1350-1355

http://dx.doi.org/10.1007/s10350-008-9341-1 | Medline

[22.]

A.J. Senagore, C.P. Delaney.

A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases.

Am J Surg, 191 (2006), pp. 377-380

http://dx.doi.org/10.1016/j.amjsurg.2005.10.039 | Medline

[23.]

J. Baixauli, C.P. Delaney, A.J. Senagore, F.H. Remzi, V.W. Fazio.

Portal vein thrombosis after laparoscopic sigmoid colectomy for diverticulitis: report of a case.

Dis Colon Rectum, 46 (2003), pp. 550-553

http://dx.doi.org/10.1097/01.DCR.0000059655.70456.14 | Medline

[24.]

L. Casciola, G. Ceccarelli, L. Di Zitti, R. Valeri, R. Bellochi, A. Bartoli, et al.

Laparoscopic right hemicolectomy with intracorporeal anastomosis. Technical aspects and personal experience.

Minerva Chir, 58 (2003), pp. 621-627

Medline

[25.]

I. Baca, Z. Perko, I. Bokan, Z. Mimica, A. Petricevic, N. Druzijanic, et al.

Technique and survival after laparoscopically assisted right hemicolectomy.

Surg Endosc, 19 (2005), pp. 650-655

http://dx.doi.org/10.1007/s00464-004-9068-6 | Medline

[26.]

A.M. Kaiser, J.C. Kang, L.S. Chan, P. Vukasin, R.W. Beart.

Laparoscopic-assisted vs.,open colectomy for colon cancer: a prospective randomized trial.

Laparoendosc Adv Surg Tech J A, 14 (2004), pp. 329-334

[27.]

E.R. Winslow, J.W. Fleshman, E.H. Birnbaum, L.M. Brunt.

Wound complications of laparoscopic vs open colectomy.

Surg Endosc, 16 (2002), pp. 1420-1425

http://dx.doi.org/10.1007/s00464-002-8837-3 | Medline

[28.]

R. Singh, A. Omiccioli, S. Hegge, C. McKinley.

Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates?.

Surg Endosc, 22 (2008), pp. 2596-2600

http://dx.doi.org/10.1007/s00464-008-9845-8 | Medline

[29.]

K. Kisielinski, J. Conze, A.H. Murken, N.N. Lenzen, U. Klinge, V. Schumpelick.

The Pfannenstiel or so called “bikini cut”: still effective more than 100 years after first description.

Hernia, 8 (2004), pp. 177-181

http://dx.doi.org/10.1007/s10029-004-0210-0 | Medline

[30.]

J.C. Li, S.S. Hon, S.S. Ng, J.F. Lee, R.Y. Yiu, K.L. Leung.

The learning curve for laparoscopic colectomy: experience of a surgical fellow in an university colorectal unit.

Surg Endosc, 23 (2009), pp. 1603-1608

http://dx.doi.org/10.1007/s00464-009-0497-0 | Medline

☆

Speech presented at XVIII Jornadas Internacionales. “Masterclass” en Coloproctología (18th International Conference. Masterclass in Coloproctology). Colorectal Laparoscopic Surgery. 24–26 February, 2010, in Baiona, Spain.

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