title: A totally mini-invasive approach for colorectal laparoscopic surgery.
abstract: OBJECTIVE
  To study the short-term outcome of patients treated with laparoscopic right colectomy and how intracorporeal anastomosis has improved the outcome.
  
  
  METHODS
  We retrospectively examined all patients affected by colorectal cancer who underwent a laparoscopic right colectomy between January 2006 and December 2010 in our department. Our evaluation criteria were: diagnosis of colorectal carcinoma at presurgical biopsy, elective surgery, and the same surgeon. We excluded: emergency surgery, conversions from laparotomic colectomy, and other surgeons. The endpoints we examined were: surgical time, number of lymph nodes removed, length of stay (removal of nasogastric tube, bowel movements, gas evacuation, solid and liquid feeding, hospitalization), and major complications. Seventy-two patients were divided into two groups: intracorporeal anastomosis (39 patients) and extracorporeal anastomosis (33 patients).
  
  
  RESULTS
  Significant differences were observed between intracorporeal vs extracorporeal anastomosis, respectively, for surgical times (186.8 min vs 184.1 min, P < 0.001), time to resumption of gas evacuation (3 d vs 3.5 d, P < 0.001), days until resumption of bowel movements (3.8 d vs 4.9 d, P < 0.001), days until resumption of liquid diet (3.5 d vs 4.5 d, P < 0.001), days until resuming a solid diet (4.6 d vs 5.7 d, P < 0.001), and total hospitalization duration (7.4 d vs 8.5 d, P < 0.001). In the intracorporeal group, on average, 19 positive lymph nodes were removed; in the extracorporeal group, on average, 14 were removed P < 0.001). Thus, intracorporeal anastomosis for right laparoscopic colectomy improved patient outcome by providing faster recovery of nutrition, faster recovery of intestinal function, and shorter hospitalization than extracorporeal anastomosis.
  
  
  CONCLUSIONS
  Short-term outcomes favor intracorporeal anastomosis, confirming that a less traumatic surgical approach improves patient outcome.
authors.affiliation: Department of Surgery, Arcispedale S. Anna, Medical University of Ferrara, Ferrara, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Anania
authors.forename: Mirco
authors.initials: M
authors.lastname: Santini
authors.forename: Lucia
authors.initials: L
authors.lastname: Scagliarini
authors.forename: Alice
authors.initials: A
authors.lastname: Marzetti
authors.forename: Laura
authors.initials: L
authors.lastname: Vedana
authors.forename: Serafino
authors.initials: S
authors.lastname: Marino
authors.forename: Claudio
authors.initials: C
authors.lastname: Gregorio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Resta
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cavallesco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome