Totally laparoscopic right hemicolectomy with intracorporeal anastomosis is a technically and oncologically safe procedure.
BACKGROUND
During laparoscopic right hemicolectomy, most surgeons perform an extracorporeal anastomosis. A totally laparoscopic procedure with intracorporeal anastomosis may improve cosmesis because midline- or paraumbilical incisions can be avoided. Here, we investigate the safety of an intracorporeal anastomosis from a technical and oncological perspective.


METHODS
All patients who underwent right hemicolectomy with intracorporeal anastomosis between 2003-2011 were retrospectively analyzed. Parameters were duration of surgery, intraoperative blood loss, mortality and morbidity. Adequacy of oncologic resections was scored by resectional margins and number of harvested lymph nodes.


RESULTS
A total of 162 patients were included with a median age of 69 years (IQR60-76). The duration of surgery was 100 minutes (80-120) and intraoperative blood loss was 30 mL (10-100). Hundred-twenty patients (74%) underwent an oncologic resection. Number of harvested lymph nodes was 12 (9-18). RO-resection was achieved in 100%. Four patients died (2.5%). Postoperative complications were: anastomotic leakage (3.1%; n = 5), ileus (4.9%; n = 8), abscesses (2.5% ; n = 4), wound infection (3.1% ; n = 5) and cardiopulmonary complications (10.5% ; n = 17). Duration of oncological follow-up was 2.5 years (1.3-4.6). Local recurrence and overall survival rates at two years were 0.8% and 85.4%, respectively.


CONCLUSIONS
Right hemicolectomy with intracorporeal anastomosis is a technically and oncologically safe procedure with acceptable operating time and low mortality.
Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands. v.kornmann@antoniusziekenhuis.nl
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Kornmann
Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
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Hagendoorn
Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
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van Koeverden
Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
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van Ramshorst
Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
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Smits
D000368:Aged; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging