Watanabe Katsuya, Oshikiri Taro, Habu Kyosuke, Ogi Yusuke, Sugishita Hiroki, Akita Satoshi, Yoshida Motohira, Koga Shigehiro, Ishimaru Kei, Watanabe Yuji
Division of Gastrointestinal Surgery and Surgical Oncology, Graduate School of Medicine, Ehime University, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Surg Today. 2025 May 24. doi: 10.1007/s00595-025-03054-6.
The incidence of colorectal cancer (CRC) is increasing worldwide. Surgical resection is the primary treatment for localized cases with the aim of complete tumor removal and adequate lymph node dissection. Intracorporeal anastomosis (IA) has gained popularity in colorectal surgery; however, its oncological benefits over extracorporeal anastomosis (EA) remain unclear.
This retrospective study at Ehime University Hospital included 118 right-sided colon cancer patients (54 IA and 64 EA) treated between 2018 and 2023. Outcomes such as distal margin (DM) length and number of lymph nodes dissected were assessed.
In the IA group, the DM was significantly longer (117.9 ± 49.5 mm vs. 78.2 ± 30.1 mm, p < 0.001) and more lymph nodes were harvested (22.2 ± 10.0 vs. 18.2 ± 9.9, p = 0.031). A multivariate analysis identified IA as an independent factor for DM > 10 cm (odds ratio [OR] = 0.25, p = 0.001) and > 12 dissected lymph nodes (OR = 0.15, p = 0.006). Patients with IA resumed ingestion and defecation sooner, with shorter hospital stays.
IA provides significant advantages for DM length and lymph node dissection, suggesting that it may be preferable for right-sided colon cancer surgery.
全球范围内，结直肠癌（CRC）的发病率正在上升。手术切除是局限性病例的主要治疗方法，目的是完全切除肿瘤并进行充分的淋巴结清扫。体内吻合术（IA）在结直肠手术中越来越受欢迎；然而，与体外吻合术（EA）相比，其肿瘤学益处仍不明确。
这项在爱媛大学医院进行的回顾性研究纳入了2018年至2023年期间接受治疗的118例右侧结肠癌患者（54例行IA，64例行EA）。评估了诸如远端切缘（DM）长度和清扫淋巴结数量等结果。
在IA组中，DM明显更长（117.9±49.5毫米对78.2±30.1毫米，p<0.001），并且清扫的淋巴结更多（22.2±10.0对18.2±9.9，p=0.031）。多因素分析确定IA是DM>10厘米（优势比[OR]=0.25，p=0.001）和清扫淋巴结>12个（OR=0.15，p=0.006）的独立因素。接受IA的患者恢复进食和排便更快，住院时间更短。
IA在DM长度和淋巴结清扫方面具有显著优势，表明它可能更适合右侧结肠癌手术。
