Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.670
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
Processing time: 108 Days and 22 Hours
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.
To clarify the effects of bacterial and tumor cell contamination of the intra-abdominal cavity in IA.
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.
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.
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.
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.