title: Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers.
abstract: BACKGROUND
  Although nowadays considered as feasible and effective surgery in terms of short- and long-term results and oncological radicality, laparoscopic right colectomy is performed by a small number of surgeons, and in the vast majority of cases, this technique was performed with an extracorporeal anastomosis. Current literature failed to solve the controversies between intracorporeal and extracorporeal anastomosis after laparoscopic right colectomy.
  
  
  METHODS
  A multicenter case-controlled study has been designed, including 286 patients who underwent laparoscopic right hemicolectomy with intracorporeal anastomosis (IA) compared with 226 matched patients who underwent laparoscopic right hemicolectomy with extracorporeal anastomosis (EA).
  
  
  RESULTS
  There was no significant difference in terms of age, sex, BMI, and ASA score between the two groups. Surgical post history, tumor localization, and stage of disease according to AJCC/UICC TNM were similar too. Although similar oncologic radicality in term of number of lymph nodes harvested (25.7 ± 10.7 of IA group vs. 24.8 ± 8.7 of EA group; p = 0.3), as well as similar operative time (166 ± 43.7 min. in IA group vs. 157.5 ± 67.2 min in EA group) have been registered, time to flatus was statistically lower after intracorporeal anastomosis (40.8 ± 24.3 h in TLRC group vs. 55.2 ± 19.2 h in LARC group; p < 0.001) Laparoscopic colectomy with intracorporeal anastomosis was associated with a lower rate of post-operative complications (OR 0.65, 95 % CI 0.44, 0.95, p = 0.027). However, when stratifying according to clavien classification, the difference was consistently confirmed for less severe (class I and II) complications (OR 0.63, 95 % CI 0.42, 0.94, p = 0.025), but not for class III, IV, and V complications (OR 1.015, 95 % CI 0.64, 1.6, p = 0.95).
  
  
  CONCLUSIONS
  Our results are encouraging to consider the intracorporeally approach the better way to fashion the anastomosis after laparoscopic right colectomy. This study clearly provides the rationale for a randomized clinical trial, which would be useful to give definitive conclusion.
authors.affiliation: University "Federico II", Via Pansini 5, 80131, Naples, Italy, milone.marco@alice.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Milone
authors.forename: Ugo
authors.initials: U
authors.lastname: Elmore
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Salvo
authors.forename: Paolo
authors.initials: P
authors.lastname: Delrio
authors.forename: Luigi
authors.initials: L
authors.lastname: Bucci
authors.forename: Giuseppe Paolo
authors.initials: GP
authors.lastname: Ferulano
authors.forename: Carmine
authors.initials: C
authors.lastname: Napolitano
authors.forename: Maria Rachele
authors.initials: MR
authors.lastname: Angiolini
authors.forename: Umberto
authors.initials: U
authors.lastname: Bracale
authors.forename: Marco
authors.initials: M
authors.lastname: Clemente
authors.forename: Michele
authors.initials: M
authors.lastname: D'ambra
authors.forename: Gaetano
authors.initials: G
authors.lastname: Luglio
authors.forename: Mario
authors.initials: M
authors.lastname: Musella
authors.forename: Ugo
authors.initials: U
authors.lastname: Pace
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
authors.forename: Francesco
authors.initials: F
authors.lastname: Milone
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications; D016896:Treatment Outcome