Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2025; 17(3): 99124
Published online Mar 15, 2025. doi: 10.4251/wjgo.v17.i3.99124
Is intraperitoneal isoperistaltic side-to-side anastomosis a safe surgical procedure in radical colon cancer surgery
Bin Wu, Jing-Tao Zhu, He-Xin Lin, Yu-Hua Dai, Tian-Sheng Lin, An-Le Huang, Yi-Nan Chen, Yong-Wen Li, Hai-Bin Wang, Yi-Fu Chen, Dong-Han Chen, Huang-Dao Yu, Jun You, Qing-Qi Hong
Bin Wu, Jing-Tao Zhu, He-Xin Lin, Yu-Hua Dai, Tian-Sheng Lin, An-Le Huang, Yi-Nan Chen, Yong-Wen Li, Hai-Bin Wang, Yi-Fu Chen, Dong-Han Chen, Huang-Dao Yu, Jun You, Qing-Qi Hong, Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361003, Fujian Province, China
Co-first authors: Bin Wu and Jing-Tao Zhu.
Co-corresponding authors: Jun You and Qing-Qi Hong.
Author contributions: Wu B and Zhu JT contributed equally as co-first authors; Wu B, Zhu JT, Chen YN, Lin HX, Dai YH, Li YW, Lin TS, Huang AL, and Wang HB developed project, analyzed data and wrote manuscript; Chen YF, Chen DH, Yu HD, You J, and Hong QQ developed project, analyzed data and edited manuscript; You J and Hong QQ contributed equally as co-corresponding authors; and all authors have read and approve the final manuscript.
Supported by Bethune Charitable Foundation Project, No. HZB-20190528-10; and Natural Science Foundation of Fujian Province, No. 2020J011230.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of the First Affiliated Hospital of Xiamen University, with approval number: [2023] Scientific Research Ethics Review No. 005.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qing-Qi Hong, Chief Physician, Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, No. 55 Zhenhai Road, Siming District, Xiamen 361003, Fujian Province, China. hqqsums@aliyun.com
Received: July 14, 2024
Revised: November 12, 2024
Accepted: December 25, 2024
Published online: March 15, 2025
Processing time: 214 Days and 23.8 Hours
Abstract
BACKGROUND

Colorectal cancer, one of the most common malignancies, is primarily treated through surgery. With the widespread use of laparoscopy, gastrointestinal reconstruction remains a key area of research. The choice between intraperitoneal anastomosis (IA) and extraperitoneal anastomosis (EA) remains a subject of considerable debate. This study uses intraperitoneal isoperistaltic side-to-side anastomosis (IISSA) with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes. It is hypothesized that this technique may offer better short-term outcomes than EA.

AIM

To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.

METHODS

Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed. Surgical, postoperative, and pathological features of the IA and EA groups were observed before and after propensity score matching. Patients with right-sided and left-sided colon cancer were separated, each further divided into IA and EA groups (R-IA vs R-EA for right-sided, L-IA vs L-EA for left-sided), for stratified analysis of the aforementioned indicators.

RESULTS

After propensity score matching, 63 pairs were matched in each group. In surgical characteristics, the IA group exhibited less blood loss and shorter incisions than the EA group. Regarding postoperative recovery, the IA group showed earlier recovery of gastrointestinal function. Pathologically, the IA group had greater lymph node clearance. Relative to the R-EA group, the R-IA group experienced reduced blood loss, shorter assisted incisions, earlier recovery of gastrointestinal functions and greater lymph node dissection. When compared to the L-EA group, the L-IA group demonstrated earlier postoperative anal exhaust and defecation, along with a reduced length of hospitalization. Regarding postoperative complications, no statistically significant differences were found between the groups either after matching or in the stratified analyses.

CONCLUSION

Compared to EA, IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.

Keywords: Colon cancer; Laparoscopic surgery; Intraperitoneal anastomosis; Extraperitoneal anastomosis; Isoperistaltic side-to-side anastomosis; Hand-sewn

Core Tip: This is a study to verify the safety and short-term outcomes of intraperitoneal isoperistaltic side-to-side anastomosis with hand-sewn closure of the common opening in laparoscopic radical resection of colon cancer by comparing with extraperitoneal anastomosis. The results confirmed that intraperitoneal isoperistaltic side-to-side anastomosis with hand-sewn closure of the common opening had better short-term efficacy under the premise of ensuring safety. This study provides a reliable method of digestive tract reconstruction for colon cancer radical resection.