Department of Surgical Sciences, University of Torino, Torino, Italy.
Division of Nuclear Medicine, University of Torino, Torino, Italy.
Ann Surg. 2019 Nov;270(5):762-767. doi: 10.1097/SLA.0000000000003519.
The aim of the study was to determine whether there are clinically relevant differences in outcomes between laparoscopic right colectomy (LRC) with intracorporeal ileocolic anastomosis (IIA) and LRC with extracorporeal IA (EIA).
IIA and EIA are 2 well-established techniques for restoration of bowel continuity after LRC. There are no high-quality studies demonstrating the superiority of one anastomotic technique over the other.
This is a double-blinded randomized controlled trial comparing the outcomes of LRC with IIA and LRC with EIA in patients with a benign or malignant right-sided colon neoplasm. Primary endpoint was length of hospital stay (LOS). This trial was registered with ClinicalTrials.gov, number NCT03045107.
A total of 140 patients were randomized and analyzed. Median operative time was comparable in IIA versus EIA group {130 [interquartile range (IQR) 105-195] vs 130 (IQR 110-180) min; P = 0.770} and no intraoperative complications occurred. The quicker recovery of bowel function after IIA than EIA [gas: 2 (IQR 2-3) vs 3 (IQR 2-3) days, P = 0.003; stool: 4 (IQR 3-5) vs 4.5 (IQR 3-5) days, P = 0.032] was not reflected in any advantage in the primary endpoint: median LOS was similar in the 2 groups [6 (IQR 5-7) vs 6 (IQR 5-8) days; P = 0.839]. No significant differences were observed in the number of lymph nodes harvested, length of skin incision, 30-day morbidity (17.1% vs 15.7%, P = 0.823), reoperation rate, and readmission rate between the 2 groups.
LRC with IIA is associated with earlier recovery of postoperative bowel function than LRC with EIA; however, it does not reflect into a shorter LOS.
本研究旨在确定腹腔镜右半结肠切除术（LRC）行腔内回肠结肠吻合术（IIA）与行腔外吻合术（EIA）的患者在结局方面是否存在临床相关差异。
IIA 和 EIA 是 LRC 后重建肠连续性的两种成熟技术。尚无高质量研究证明一种吻合技术优于另一种。
这是一项比较腹腔镜右半结肠切除术行 IIA 与 EIA 的患者结局的双盲随机对照试验，入组患者患有良性或恶性右侧结肠肿瘤。主要终点是住院时间（LOS）。该试验在 ClinicalTrials.gov 注册，编号为 NCT03045107。
共纳入 140 例患者进行随机分组和分析。IIA 组与 EIA 组的中位手术时间相当[130（四分位距 [IQR] 105-195）比 130（IQR 110-180）min；P = 0.770]，且术中无并发症发生。IIA 组术后肠功能恢复更快[排气：2（IQR 2-3）比 3（IQR 2-3）d，P = 0.003；排便：4（IQR 3-5）比 4.5（IQR 3-5）d，P = 0.032]，但这并未体现在主要终点方面的优势：2 组 LOS 中位数相似[6（IQR 5-7）比 6（IQR 5-8）d；P = 0.839]。2 组间的淋巴结清扫数目、皮肤切口长度、30 天发病率（17.1%比 15.7%，P = 0.823）、再次手术率和再入院率均无显著差异。
LRC 行 IIA 与 EIA 相比，术后肠功能恢复更快，但 LOS 并未缩短。
