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