Hanna Mark H, Hwang Grace S, Phelan Michael J, Bui Thanh-Lan, Carmichael Joseph C, Mills Steven D, Stamos Michael J, Pigazzi Alessio
Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 850, Orange, CA, 92868, USA.
Department of Surgery, University of Southern California, Los Angeles, CA, USA.
Surg Endosc. 2016 Sep;30(9):3933-42. doi: 10.1007/s00464-015-4704-x. Epub 2015 Dec 29.
The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA).
A retrospective chart review of 195 consecutive patients who underwent laparoscopic right hemicolectomy by four colorectal surgeons at three institutions from March 2005 to June 2014 was performed. Multivariate regression analysis was used to compare postoperative and oncologic outcomes.
A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups.
IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising outcomes.
腹腔镜右半结肠切除术的应用日益广泛，使得肠道重建可选择完全腹腔镜体内吻合术（IA）。该技术可能会缓解外科医生在腹腔镜辅助体外吻合术（EA）中面临的一些技术限制。
对2005年3月至2014年6月期间在三家机构由四位结直肠外科医生进行腹腔镜右半结肠切除术的195例连续患者进行回顾性病历审查。采用多因素回归分析比较术后和肿瘤学结局。
在研究期间，共有195例患者接受了腹腔镜右半结肠切除术，其中86例（44%）患者接受IA，109例（56%）患者接受EA。两组最常见的手术指征均为癌症：IA组56例（65%），EA组57例（52%）。与EA相比，IA的轻微并发症发生率显著更高，但严重并发症无差异。EA中转开腹切除的比例更高。通过多因素分析比较IA与EA，在住院时间、肠功能恢复、吻合口漏风险、腹腔内脓肿风险或伤口并发症风险方面无显著差异。在癌症切除术中，两组采集的淋巴结中位数无显著差异（IA组18枚淋巴结，EA组19枚淋巴结，P>0.05）。两组在5.7年的总生存率和无病生存率方面也无显著差异。
腹腔镜右半结肠切除术中的IA与EA相比，术后和肿瘤学结局相似。IA在中转和标本取出的灵活性方面可能具有优势，但这被较高的轻微并发症发生率所抵消。这些发现表明，IA是经验丰富的结直肠外科医生的有效技术手段，且不影响手术效果。
