Kim Seijong, Huh Jung Wook, Lee Woo Yong, Yun Seong Hyeon, Kim Hee Cheol, Cho Yong Beom, Park Yoonah, Shin Jung Kyong
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Surgery. 2025 Apr;180:109051. doi: 10.1016/j.surg.2024.109051. Epub 2024 Dec 30.
Despite advancements in laparoscopic right hemicolectomy for right-sided colon cancer, the choice between functional end-to-end anastomosis and end-to-side anastomosis remains a topic of debate. This study aimed to compare these 2 techniques in terms of postoperative complications and disease-free survival.
This retrospective analysis included 1,202 patients who underwent laparoscopic right hemicolectomy for nonmetastatic colon cancer at Samsung Medical Center between January 2007 and February 2016. The patients were divided into functional end-to-end anastomosis (n = 968) and end-to-side anastomosis (n = 234) groups based on the anastomosis technique used. Patients' characteristics, oncologic results, operative outcomes, and postoperative complications were analyzed.
The baseline characteristics were similar between the 2 groups, except for a higher incidence of cancer obstruction in the end-to-side anastomosis group (P < .001). After matching, no significant differences were observed in operation time, blood loss, length of hospital stay, time to the first meal, or time to first flatus. Anastomotic leakage rates were comparable (functional end-to-end anastomosis 0.6% vs end-to-side anastomosis 0.4%, P > .999). The functional end-to-end anastomosis group had a higher rate of postoperative ileus (4.9% vs 1.3%, P = .017). Multivariable analysis indicated age, sex, and anastomosis type as significant predictors of postoperative ileus.
The study findings demonstrate that both functional end-to-end and end-to-side anastomosis techniques in laparoscopic right hemicolectomy are comparable in terms of operation metrics and disease-free survival. However, functional end-to-end anastomosis is associated with a higher incidence of postoperative ileus. These findings can guide surgical decision-making in the treatment of right-sided colon cancer.
尽管腹腔镜右半结肠切除术在治疗右侧结肠癌方面取得了进展，但功能性端端吻合术与端侧吻合术之间的选择仍是一个有争议的话题。本研究旨在比较这两种技术在术后并发症和无病生存率方面的差异。
这项回顾性分析纳入了2007年1月至2016年2月期间在三星医疗中心接受腹腔镜右半结肠切除术治疗非转移性结肠癌的1202例患者。根据所采用的吻合技术，将患者分为功能性端端吻合术组（n = 968）和端侧吻合术组（n = 234）。分析了患者的特征、肿瘤学结果、手术结果和术后并发症。
两组的基线特征相似，但端侧吻合术组的癌症梗阻发生率较高（P <.001）。匹配后，在手术时间、失血量、住院时间、首次进食时间或首次排气时间方面未观察到显著差异。吻合口漏发生率相当（功能性端端吻合术为0.6%，端侧吻合术为0.4%，P >.999）。功能性端端吻合术组的术后肠梗阻发生率较高（4.9%对1.3%，P =.017）。多变量分析表明年龄、性别和吻合类型是术后肠梗阻的重要预测因素。
研究结果表明，腹腔镜右半结肠切除术中的功能性端端吻合术和端侧吻合术在手术指标和无病生存率方面相当。然而，功能性端端吻合术与术后肠梗阻的发生率较高有关。这些发现可为右侧结肠癌的手术决策提供指导。
