Short-term outcomes of extracorporeal versus intracorporeal side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer: an affiliated study of a multicenter snapshot study.

Background: Laparoscopic right hemicolectomy (RHC) is the primary surgical approach for right-sided colon cancer. Different ileo-colonic anastomosis techniques may lead to varied postoperative outcomes. This study aims to compare intracorporeal versus extracorporeal side-to-side anastomosis post laparoscopic RHC for short-term outcomes in right-sided colon cancer patients.

Methods: This prospective, multicenter, cohort study utilized 1:1 propensity score matching (PSM) and inverse propensity of treatment weighting (IPTW) to address baseline imbalances. The primary endpoint was the incidence of anastomotic leakage (AL) within 30 days postoperatively, with its definition, diagnosis, and grading criteria standardized according to a published study.

Results: A total of 1028 eligible patients were analyzed, with 316 in the intracorporeal anastomosis (IA) group and 712 in the extracorporeal anastomosis (EA) group. After both PSM and IPTW, all 17 covariates were balanced between groups. No statistically significant difference in AL incidence was found between the two groups (before matching, 1.8% in EA and 1.6% in IA, P = 0.78; PSM, 1.3% in EA and 1.6% in IA, P = 0.74; IPTW, 1.9% in EA and 1.6% in IA, P = 0.76). However, peak C-reactive protein levels within 3 days postoperatively were higher in the EA group (before matching, P < 0.001; PSM, P < 0.001; IPTW, P = 0.003). Patients in the IA group had earlier postoperative defecation (before matching, P = 0.01; PSM, P < 0.001) and a shorter total hospital stay (before matching, P = 0.01; IPTW, P = 0.046). Post-PSM analysis showed earlier flatus in the IA group (P = 0.03), while post-IPTW analysis indicated later postoperative eating resumption in the IA group (P = 0.046).

Conclusions: Intracorporeal anastomosis during laparoscopic RHC for right-sided colon cancer does not increase the incidence of AL or other short-term complications. Furthermore, it facilitates postoperative bowel function recovery.