Short-term outcomes of intracorporeal anastomosis in laparoscopic colectomy for colon cancer: A nationwide, multi-institutional cohort study in Japan (ICAN study)
Tomohiro Yamaguchi, Keitaro Tanaka, Jun Watanabe, Hiroki Hamamoto, Atsushi Nishimura, Fumihiko Fujita, Hirokazu Suwa, Masaaki Ito, Kazushige Kawai, Junichiro Hiro, Seiichiro Yamamoto, Sho Nambara, Masato Ota, Yuri Ito, Junji Okuda, Masafumi Inomata, Masahiko Watanabe, Takeshi Naitoh, ICAN Collaborative Study Group of the Japan Society of Laparoscopic Colorectal Surgery
{"title":"Short-term outcomes of intracorporeal anastomosis in laparoscopic colectomy for colon cancer: A nationwide, multi-institutional cohort study in Japan (ICAN study)","authors":"Tomohiro Yamaguchi, Keitaro Tanaka, Jun Watanabe, Hiroki Hamamoto, Atsushi Nishimura, Fumihiko Fujita, Hirokazu Suwa, Masaaki Ito, Kazushige Kawai, Junichiro Hiro, Seiichiro Yamamoto, Sho Nambara, Masato Ota, Yuri Ito, Junji Okuda, Masafumi Inomata, Masahiko Watanabe, Takeshi Naitoh, ICAN Collaborative Study Group of the Japan Society of Laparoscopic Colorectal Surgery","doi":"10.1002/ags3.12915","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Several randomized controlled trials and meta-analyses have demonstrated the potential advantages of intracorporeal over extracorporeal anastomosis. However, the heterogeneity and small samples of these studies complicate drawing clear conclusions regarding such advantages. In this nationwide, multicenter, retrospective cohort study, we aimed to clarify the benefits of intracorporeal over extracorporeal anastomosis in patients undergoing laparoscopic colectomy for colon cancer.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This study included 46 institutions. Patients with clinical stage 0–III colon adenocarcinoma who underwent laparoscopic colectomy between January 2020 and December 2021 were evaluated. The effect of intracorporeal anastomosis on short-term outcomes compared to extracorporeal anastomosis was assessed using propensity score matching.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 1245 patients (intracorporeal, <i>n</i> = 615; extracorporeal, <i>n</i> = 630) were included in the final analysis. The operative time was longer (228 vs. 207 min, <i>p</i> < 0.001), but blood loss was also lower (5.0 vs. 10.0 mL, <i>p</i> < 0.001) and the incidence of intraoperative vascular injury appeared lower (0.5% vs. 1.6%, <i>p</i> = 0.091) in the intracorporeal group than those in the extracorporeal group. The time to first passage of stool (2.9 vs. 3.5 days, <i>p</i> < 0.001) and length of hospital stay (9.3 vs. 10.2 days, <i>p</i> = 0.008) were shorter in the intracorporeal group.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Intracorporeal anastomosis showed advantages over extracorporeal anastomosis in terms of blood loss, intraoperative vascular injury (potentially), bowel recovery, and length of hospital stay, despite the longer operative time.</p>\n </section>\n </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"9 4","pages":"739-749"},"PeriodicalIF":2.9000,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12915","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Gastroenterological Surgery","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ags3.12915","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Several randomized controlled trials and meta-analyses have demonstrated the potential advantages of intracorporeal over extracorporeal anastomosis. However, the heterogeneity and small samples of these studies complicate drawing clear conclusions regarding such advantages. In this nationwide, multicenter, retrospective cohort study, we aimed to clarify the benefits of intracorporeal over extracorporeal anastomosis in patients undergoing laparoscopic colectomy for colon cancer.
Methods
This study included 46 institutions. Patients with clinical stage 0–III colon adenocarcinoma who underwent laparoscopic colectomy between January 2020 and December 2021 were evaluated. The effect of intracorporeal anastomosis on short-term outcomes compared to extracorporeal anastomosis was assessed using propensity score matching.
Results
A total of 1245 patients (intracorporeal, n = 615; extracorporeal, n = 630) were included in the final analysis. The operative time was longer (228 vs. 207 min, p < 0.001), but blood loss was also lower (5.0 vs. 10.0 mL, p < 0.001) and the incidence of intraoperative vascular injury appeared lower (0.5% vs. 1.6%, p = 0.091) in the intracorporeal group than those in the extracorporeal group. The time to first passage of stool (2.9 vs. 3.5 days, p < 0.001) and length of hospital stay (9.3 vs. 10.2 days, p = 0.008) were shorter in the intracorporeal group.
Conclusions
Intracorporeal anastomosis showed advantages over extracorporeal anastomosis in terms of blood loss, intraoperative vascular injury (potentially), bowel recovery, and length of hospital stay, despite the longer operative time.
背景：一些随机对照试验和荟萃分析已经证明了体内吻合比体外吻合有潜在的优势。然而，这些研究的异质性和小样本使得得出关于这些优势的明确结论变得复杂。在这项全国性、多中心、回顾性队列研究中，我们旨在阐明在接受腹腔镜结肠切除术的结肠癌患者中，体外吻合优于体外吻合的益处。方法纳入46所医院。对2020年1月至2021年12月期间接受腹腔镜结肠切除术的临床0-III期结肠腺癌患者进行评估。与体外吻合相比，采用倾向评分匹配法评估体内吻合对短期预后的影响。结果共1245例患者(体内，n = 615；体外实验（n = 630）纳入最终分析。手术时间更长（228 vs. 207 min, p < 0.001），但出血量也较低（5.0 vs. 10.0 mL, p < 0.001），术中血管损伤发生率较体外组低（0.5% vs. 1.6%, p = 0.091）。体内组首次排便时间（2.9天vs. 3.5天，p < 0.001）和住院时间（9.3天vs. 10.2天，p = 0.008）较短。结论尽管手术时间较长，但在失血量、术中血管损伤（潜在）、肠道恢复、住院时间等方面均优于体外吻合。
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
