Intracorporeal Anastomosis Versus Extracorporeal Anastomosis in Laparoscopic Right Colectomy: An Observational Cohort Study
Authors: Sun Rui , Zhang Yuelun , Feng Bo , Su Xiangqian , Sun Yueming , Xu Lai , Lu Junyang , Zhang Guannan , Wu Aiwen , Kang Liang , Deng Haijun , Chi Pan , Zhong Ming , Zheng Minhua , Xiao Yi ,   the RELARC Study Group, Xu Lai , Su Xiangqian , He Xiangqian , Zhang Xiangqian , Lu Xiangqian , Chen Lei , Zhang Guannan , Feng Bo , Zang Lu , Ma Junjun , Sun Yueming , Feng Yifei , Ji Dongjian , Du Xiaohui , He Changzheng , Fu Ze , Chi Pan , Huang Ying , Jiang Weizhong , Wang Ziqiang , Wu Qingbin , Zhong Ming , Yu Minhao , Wu Aiwen , Chen Pengju , Zhu Anlong , Guan Wenlong , Wu Bin , Li Fei , Li Ang , Xu Jianmin , He Guodong , Kang Liang , He Xiaowen , Suo Jian , Wang Daguang , Deng Haijun , Wang Yanan , Ye Yingjiang , Shen Kai , Lin Guole , Yao Hongwei , Qiu Huizhong , Ding Kefeng , Xu Tao , Liang Zhiyong , Zhou Weixun , Xue Huadan , Li Bin , Zhang Zhongtao , Zheng Minhua , Xiao Yi 
Published: January 2023

Background

Current studies did not draw definitive conclusions on comparison of intracorporeal anastomosis (ICA) with extracorporeal anastomosis (ECA) in laparoscopic right colectomy. Whether the intraperitoneal contamination induced by ICA can result in higher risk of postoperative abdominal infection remains unclear. This study was aimed to compare the short‐term outcomes, especially the risk of abdominal infection after ICA versus ECA.

Methods

This was an observational cohort study as a secondary analysis of a randomized controlled trial (RCT)—RELARC trial (NCT02619942). The patients enrolled in the RELARC trial were diagnosed with primary colon adenocarcinoma without distant metastasis and underwent radical laparoscopic right colectomy between Jan 2016 and Dec 2019. In our study the patients who converted to open surgery in RELARC trial were excluded. The short‐term outcomes were compared between ICA and ECA. The primary endpoint was abdominal infection. The inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) was used for adjusting the potential confounders.

Results

This study enrolled 975 patients with 119 patients undergoing ICA and 856 patients undergoing ECA. The incidence of abdominal infection was higher in ICA group (9.2% versus 1.5%, RR from IPTW = 5.7 (95%CI: 2.6–12.6), P < 0.001) as well as the incidence of wound infection (14.3% vs 3.3%, RR from IPTW = 5.0 (95%CI: 2.9–8.6), P < 0.001). ICA was associated with higher incidence of Clavien–Dindo (CD) grade I and II complications (CD‐I: 15.1% versus 6.8%, RR from IPTW = 2.4 (95%CI: 1.5–3.9), P < 0.001; CD‐II: 26.9% versus 8.2%, RR from IPTW = 3.6 (95%CI: 2.5–5.1), P < 0.001) but similar incidence of CD‐III ~ IV complications compared to ECA (3.4% vs 2.1%, RR from IPTW = 1.2 (95%CI: 0.4–4.0), P = 0.73). In ICA group, choosing another incision rather than lengthening main port site decreased the incidence of wound infection although without statistical significance (17.3% (14/81) versus 7.9% (3/38), crude RR = 2.2 (95%CI: 0.7–7.2), P = 0.17).

Conclusion

ICA is likely to be associated with higher risk of abdominal infection and CD‐I ~ II complications.