Intra-corporeal anastomosis vs Extra-corporeal anastomosis following laparoscopic right hemicolectomy, surgical outcomes of single center observational study

Introduction Enhanced recovery after surgery (ERAS) protocol strongly recommends minimally invasive approach to colon cancer for rapid recovery, lower complication rate, and wound related complications. Intracorporeal anastomosis (ICA) is believed to offer better patient outcome compared to extracorporeal anastomosis (ECA). Methods From January 2021 to January 2022, a prospective observational study comparing intracorporeal anastomosis (ICA) to extracorporeal anastomosis (ECA) in patients after elective right hemicolectomy at local surgical hospital was conducted. We included all patients ≥18 years old underwent elective right hemicolectomy. Primary outcome was difference in incidence of surgical site infection and anastomotic leakage postoperatively. Results Seventy-one patients had ICA with mean age 52 ± 9.8 while 67 patients had ECA with mean age 54.2 ± 8.7. Mean over all operative time was longer after ICA (169.1 ± 35.7) compared to ECA group (147 ± 36.9), p = 0.0001. Difference in estimated blood loss (p = 0.60), tumor size (p = 0.57), number of excised lymph nodes (p = 0.19), stage (p = 0.66), and pathology of specimen (p = 0.53) between ICA and ECA was non-significant. Patients with ICA after right hemicolectomy had a quicker recovery of bowel function, time to pass stool, ( ICA: 3.74 ± 0.6 vs ECA: 4 ± 0.5,p = 0.009), early commencement of oral intake (ICA: 2.6 ± 1.1 vs ECA: 3.6 ± 1.1,p = 0.0001), and less days in hospital (ICA: 4.8 ± 1.1 vs ECA: 6.2 ± 1.4,p = 0.0001) compared to patients with ECA, respectively. No significant differences in postoperative complications and causes of readmission between 2 groups. Conclusion ICA offers comparable postoperative complications to ECA but has enhanced patient outcomes in terms of recovery.