Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 670-680
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.670
Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis
Hajime Kayano, Nana Mamuro, Yutaro Kamei, Takashi Ogimi, Hiroshi Miyakita, Toshio Nakagohri, Kazuo Koyanagi, Masaki Mori, Seiichiro Yamamoto
Hajime Kayano, Nana Mamuro, Yutaro Kamei, Takashi Ogimi, Hiroshi Miyakita, Toshio Nakagohri, Kazuo Koyanagi, Masaki Mori, Seiichiro Yamamoto, Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 259-1193, Kanagawa, Japan
Author contributions: Kayano H designed the study, analyzed the data, and wrote the paper; Mamuro N, Kamei Y, Ogimi T, and Miyakita H collected the data; Mori M, Nakagohri T, and Koyanagi K supervised this study; and Yamamoto S designed the study and supervised writing of the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Review Committee of the Research Ethics Committee, Tokai University School of Medicine (23RC011).
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: The datasets analyzed during the current study are available from the corresponding author on reasonable request.
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.
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: Hajime Kayano, MD, PhD, Associate Professor, Department of Gastroenterological Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara 259-1193, Kanagawa, Japan. h.kayano@tsc.u-tokai.ac.jp
Received: December 4, 2023
Peer-review started: December 4, 2023
First decision: December 28, 2023
Revised: January 6, 2024
Accepted: February 4, 2024
Article in press: February 4, 2024
Published online: March 27, 2024
Abstract
BACKGROUND

Although intracorporeal anastomosis (IA) for colon cancer requires longer operative time than extracorporeal anastomosis (EA), its short-term postoperative results, such as early recovery of bowel movement, have been reported to be equal or better. As IA requires opening the intestinal tract in the abdominal cavity under pneumoperitoneum, there are concerns about intraperitoneal bacterial infection and recurrence of peritoneal dissemination due to the spread of bacteria and tumor cells. However, intraperitoneal bacterial contamination and medium-term oncological outcomes have not been clarified.

AIM

To clarify the effects of bacterial and tumor cell contamination of the intra-abdominal cavity in IA.

METHODS

Of 127 patients who underwent laparoscopic colon resection for colon cancer from April 2015 to December 2020, 75 underwent EA (EA group), and 52 underwent IA (IA group). After propensity score matching, the primary endpoint was 3-year disease-free survival rates, and secondary endpoints were 3-year overall survival rates, type of recurrence, surgical site infection (SSI) incidence, number of days on antibiotics, and postoperative biological responses.

RESULTS

Three-year disease-free survival rates did not significantly differ between the IA and EA groups (87.2% and 82.7%, respectively, P = 0.4473). The 3-year overall survival rates also did not significantly differ between the IA and EA groups (94.7% and 94.7%, respectively; P = 0.9891). There was no difference in the type of recurrence between the two groups. In addition, there were no significant differences in SSI incidence or the number of days on antibiotics; however, postoperative biological responses, such as the white blood cell count (10200 vs 8650/mm3, P = 0.0068), C-reactive protein (6.8 vs 4.5 mg/dL, P = 0.0011), and body temperature (37.7 vs 37.5 °C, P = 0.0079), were significantly higher in the IA group.

CONCLUSION

IA is an anastomotic technique that should be widely performed because its risk of intraperitoneal bacterial contamination and medium-term oncological outcomes are comparable to those of EA.

Keywords: Colon cancer, Intracorporeal anastomosis, 3-year disease-free survival, Recurrence, Surgical site infection, Postoperative biological response

Core Tip: Since intracorporeal anastomosis (IA) for colon cancer is a technique in which the intestinal tract is opened in the abdominal cavity under pneumoperitoneum, there have been concerns about intraperitoneal bacterial infection and recurrent peritoneal dissemination due to the spread of bacteria and tumor cells. However, there have been few reports of the degree of bacterial contamination of the intraperitoneal cavity and the medium-term oncological outcomes. This study showed that the medium-term results of IA were comparable to those of conventional extracorporeal anastomosis and were not affected by the spread of bacteria or tumor cells.