Observation on clinical effects of intraperitoneal isoperistaltic side-to-side anastomosis combined with hand-sewn in laparoscopic radical colorectal cancer surgery

WU Bin; WU Jian-hai; XU Qiang; LIN He-xin; LI Yong-wen; CHEN Yi-nan; CHEN Dong-han; CHEN Yi-fu; WANG Hai-bin; YU Huang-dao; HUANG An-le; LIN Tian-sheng; HONG Qing-qi; YOU Jun

doi:10.19538/j.cjps.issn1005-2208.2023.12.19

Abstract：Objective To compare the clinical efficacy of intraperitoneal isoperistaltic side-to-side anastomosis combined with manual suturing and extracorporeal anastomosis(EA)in laparoscopic radical surgery for colon cancer(cancer of ileocecum ascending,transverse,descending,upper sigmoid colon).Methods A retrospective analysis of data from 80 patients who underwent laparoscopic radical surgery for colon cancer at the First Affiliated Hospital of Xiamen University from April 2019 to August 2020 was conducted.Patients were divided into two groups based on the method of digestive tract reconstruction:intracorporeal anastomosis(IA)group with 37 cases and EA group with 43 cases.Stratified analysis:According to the tumor site it was divided into 40 cases in the left side group(colo-colonic anastomosis)and 40 cases in the right side group(ileo-colonic anastomosis).Observation indicators included:(1)perioperative and postopera-tive recovery,(2)postoperative pathological conditions,and(3)follow-up and prognosis.Results(1)Perioperative and postoperative recovery:All 80 patients completed laparoscopic radical surgery for colon cancer,with no deaths during the perioperative period.The IA group showed significant advantages over the EA group in auxiliary incision length[3.00(2.50-8.00)cm vs.5.00(4.00-10.00)cm,P＜0.001],anal exhaust time[3(2-10)days vs.4(2-9)days,P=0.001],defe-cation time[6(4-11)days vs.8(4-15)days,P=0.017],initiation of liquid diet[4(2-11)days vs.5(3-11)days,P＜0.001],and length of hospital stay[8(7-24)days vs.11(6-27)days P=0.042].However,the IA group had a longeropera-tion time[(219.51±45.57)min vs.(177.91±50.46)min,P＜0.001],with statistically significant differences between the groups.There were no significant differences between the groups in terms of blood loss[50(20-200)mL vs.50(20-150)mL,P=0.502],perioperative blood infection indicators(P＞0.050),overall postoperative complication rates(16.22％vs.16.28％,P=0.994),intra-abdominal(5.41％vs.2.33％,P=0.470)and incisional infections(2.70％vs.4.65％,P=0.647).(2)Postoperative pathological conditions:There were no significant differences between the groups in terms of tumor size[(4.39±1.76)cm vs.(4.29±1.79)cm,P=0.242],gross type(P=0.816),histological type(P=0.420),number of positive lymph node clearances[1(0-10)vs.0(0-29),P=1.000],T stage(P=0.380),N stage(P=0.800),and pathological stage(P=0.836).(3)Follow-up and prognosis:All patients were followed up for 36 to 52 months,with a median follow-up time of 44 months.There were no significant differences between the two groups in terms of postoperative chemotherapy(72.97％vs.76.74％,P=0.698),tumor recurrence and metastasis(16.22％vs.16.28％,P=0.994),and survival rate(97.30％vs.95.35％,P=0.650).(4)Stratified analysis:In the left group,the IA-L group was significantly better than the EA-L group in terms of auxiliary incision length[3.00(2.50-8.00)cm vs.5.00(4.00-5.00)cm,P＜0.001],anal exhaust time[3(2-5)d vs.4(3-9)d,P=0.002],defecation time[6.5(4-9)d vs.8(4-15)d,P=0.011]and initiation of liquid diet[4(2-5)d vs.5(3-11)d,P＜0.001].However,the IA-L group had a longer operation time[205.00(160-320)min vs.157.5(120-210)min,P＜0.001].In the right-sided group,the IA-R group only had a shorter auxiliary incision length[3.00(2.50-5.00)cm vs.6.00(5.00-10.00)cm,P＜0.001]than the EA-R group with statistically significant differ-ence.Conclusion Compared with extracorporeal anastomosis,intraperitoneal isoperistaltic side-to-side anastomosis combined with manual suturing is safe and feasible in laparoscopic radical surgery for colon cancer(cancer of ileocecum,ascending,transverse,descending,upper sigmoid colon),with reliable short-term and long-term efficacy.