Yamaguchi Tomohiro, Tanaka Keitaro, Watanabe Jun, Hamamoto Hiroki, Nishimura Atsushi, Fujita Fumihiko, Suwa Hirokazu, Ito Masaaki, Kawai Kazushige, Hiro Junichiro, Yamamoto Seiichiro, Nambara Sho, Ota Masato, Ito Yuri, Okuda Junji, Inomata Masafumi, Watanabe Masahiko, Naitoh Takeshi
Department of Gastroenterological Surgery Cancer Institute Hospital of Japanese Foundation for Cancer Research Tokyo Japan.
Department of General and Gastroenterological Surgery Osaka Medical and Pharmaceutical University Takatsuki Japan.
Ann Gastroenterol Surg. 2025 Jan 21;9(4):739-749. doi: 10.1002/ags3.12915. eCollection 2025 Jul.
Several randomized controlled trials and meta-analyses have demonstrated the potential advantages of intracorporeal over extracorporeal anastomosis. However, the heterogeneity and small samples of these studies complicate drawing clear conclusions regarding such advantages. In this nationwide, multicenter, retrospective cohort study, we aimed to clarify the benefits of intracorporeal over extracorporeal anastomosis in patients undergoing laparoscopic colectomy for colon cancer.
This study included 46 institutions. Patients with clinical stage 0-III colon adenocarcinoma who underwent laparoscopic colectomy between January 2020 and December 2021 were evaluated. The effect of intracorporeal anastomosis on short-term outcomes compared to extracorporeal anastomosis was assessed using propensity score matching.
A total of 1245 patients (intracorporeal, = 615; extracorporeal, = 630) were included in the final analysis. The operative time was longer (228 vs. 207 min, < 0.001), but blood loss was also lower (5.0 vs. 10.0 mL, < 0.001) and the incidence of intraoperative vascular injury appeared lower (0.5% vs. 1.6%, = 0.091) in the intracorporeal group than those in the extracorporeal group. The time to first passage of stool (2.9 vs. 3.5 days, < 0.001) and length of hospital stay (9.3 vs. 10.2 days, = 0.008) were shorter in the intracorporeal group.
Intracorporeal anastomosis showed advantages over extracorporeal anastomosis in terms of blood loss, intraoperative vascular injury (potentially), bowel recovery, and length of hospital stay, despite the longer operative time.
多项随机对照试验和荟萃分析已证明体内吻合术相较于体外吻合术具有潜在优势。然而，这些研究的异质性和小样本量使得就此类优势得出明确结论变得复杂。在这项全国性、多中心、回顾性队列研究中，我们旨在阐明在接受腹腔镜结肠癌切除术的患者中，体内吻合术相较于体外吻合术的益处。
本研究纳入了46家机构。对2020年1月至2021年12月期间接受腹腔镜结肠切除术的临床0 - III期结肠腺癌患者进行评估。使用倾向评分匹配法评估体内吻合术与体外吻合术相比对短期结局的影响。
最终分析共纳入1245例患者（体内吻合术组，n = 615；体外吻合术组，n = 630）。体内吻合术组的手术时间更长（228分钟对207分钟，P < 0.001），但失血量更低（5.0毫升对10.0毫升，P < 0.001），术中血管损伤发生率似乎也更低（0.5%对1.6%，P = 0.091）。体内吻合术组首次排便时间（2.9天对3.5天，P < 0.001）和住院时间（9.3天对10.2天，P = 0.008）更短。
尽管手术时间较长，但体内吻合术在失血量、术中血管损伤（可能）、肠道恢复和住院时间方面显示出优于体外吻合术的优势。
