Evaluation of bacterial contamination and medium-term oncological outcomes of intracorporeal anastomosis for colon cancer: A propensity score matching analysis

Table 1 Patients’ characteristics before and after propensity score matching, n (%)

	Before propensity score matching			After propensity score matching
	IA (n = 52)	EA (n = 75)	P value	IA (n = 42)	EA (n = 42)	P value
Age (yr)	69 (38-91)	73 (38-92)	0.1289	72 (38-91)	73 (38-84)	0.7438
Sex			0.4262			0.2751
Male	24 (46.1)	40 (53.3)		19 (45.2)	24 (57.1)
Female	28 (53.8)	35 (46.6)		23 (54.7)	18 (42.8)
BMI (kg/m2)	22.2 (17.7-28.3)	22.8 (16.7-38.6)	0.5964	22.3 (17.7-28.3)	23.0 (16.7-30.2)	0.8829
ASA-PS			0.2370			0.2808
I	4 (7.6)	7 (9.3)		2 (4.7)	5 (11.9)
II	42 (80.7)	51 (68.0)		35 (83.3)	29 (69.0)
III	6 (11.5)	17 (22.6)		5 (11.9)	8 (19.0)
CCI			0.0703			0.2640
Low/medium	35 (67.3)	38 (50.6)		28 (66.6)	23 (54.7)
High	17 (32.6)	37 (49.3)		14 (33.3)	19 (45.2)
Previous abdominal operation			0.8833			0.8114
Yes	16 (30.7)	24 (32.0)		13 (30.9)	12 (28.5)
No	36 (69.2)	51 (68.0)		29 (69.0)	30 (71.4)
CEA (ng/mL)	3 (0.9-29.1)	3.5 (0.9-89.8)	0.1426	3.2 (1.0-29.1)	3.5 (0.9-42.1)	0.7807
Bowel preparation			0.7705			0.4154
MBP	21 (40.3)	35 (46.6)		17 (40.4)	23 (54.7)
OABP	29 (55.7)	37 (49.3)		24 (57.1)	18 (42.8)
None	2 (3.8)	3 (4.0)		1 (2.3)	1 (2.3)
Surgical procedure			0.0249			0.8546
Ileocecal resection	19 (36.5)	33 (44.0)		19 (45.2)	16 (38.1)
Right hemicolectomy	12 (23.0)	21 (28.0)		12 (28.5)	15 (35.7)
Left hemicolectomy	7 (13.4)	0 (0)		0 (0)	0 (0)
Sigmoidectomy	4 (7.6)	8 (10.6)		4 (9.5)	5 (11.9)
Partial resection	10 (19.2)	13 (17.3)		7 (16.6)	6 (14.2)
Lymph node dissection area			0.0133			1.0000
D2	2 (3.8)	14 (18.6)		1 (2.3)	1 (2.3)
D3	50 (96.1)	61 (81.3)		41 (97.6)	43 (97.6)
Tumor location			0.1940			0.7757
Right-sided	38 (73.0)	62 (82.6)		34 (80.9)	35 (83.3)
Left-sided	14 (26.9)	13 (17.3)		8 (19.0)	7 (16.6)
Tumor diameter (mm)	31 (0-80)	32 (0-110)	0.1722	33 (0-80)	30 (0-90)	0.9928
Differentiation			0.6351			0.9745
G1	28 (53.8)	38 (50.6)		24 (57.1)	23 (54.7)
G2	22 (42.3)	31 (41.3)		16 (38.1)	17 (40.4)
G3	2 (3.8)	6 (8.0)		2 (4.7)	2 (4.7)
T stage			0.7605			0.8268
T1-2	25 (48.0)	34 (45.3)		20 (47.6)	19 (45.2)
T3-4	27 (51.9)	41 (54.6)		23 (52.3)	23 (54.7)
N stage			0.4624			0.4834
N+	17 (32.6)	20 (26.6)		12 (28.5)	15 (35.7)
N0	35 (67.3)	55 (73.3)		30 (71.4)	27 (64.2)
Lymphatic invasion			0.3614			0.2512
Yes	32 (61.5)	52 (69.3)		25 (59.5)	30 (71.4)
No	20 (38.4)	23 (30.6)		17 (40.4)	12 (28.5)
Venous invasion			0.9346			0.4740
Yes	17 (32.6)	24 (32.0)		11 (26.2)	14 (33.3)
No	35 (67.3)	51 (68.0)		31 (73.8)	28 (66.6)
Perineural invasion			0.8157			0.3927
Yes	12 (23.0)	16 (21.3)		9 (21.4)	6 (14.2)
No	40 (76.9)	59 (78.6)		33 (78.5)	36 (85.7)
TNM stage			0.7146			0.8696
0	3 (5.7)	7 (9.3)		3 (7.1)	2 (4.7)
I	18 (34.6)	25 (33.3)		15 (35.7)	15 (35.7)
II	14 (26.9)	24 (32.0)		12 (28.5)	10 (23.8)
III	17 (32.6)	19 (25.3)		12 (28.5)	15 (35.7)

IA: Intracorporeal anastomosis; EA: Extracorporeal anastomosis; BMI: Body mass index; ASA-PS: American Society of Anesthesiologists physical status; CCI: Charlson comorbidity index; MBP: Mechanical bowel preparation; OABP: Oral antibiotic bowel preparation; CEA: Carcinoembryonic antigen.

Table 2 Surgical outcomes and short-term postoperative outcomes

	IA (n = 42)	EA (n = 42)	P value
Operative time (min)	228 (151-385)	213 (121-406)	0.1016
Blood loss (mL)	14 (3-312)	42 (4-560)	0.0087
Conversion to open surgery	0 (0)	1 (2.3)	0.3144
Intraoperative complications	0 (0)	1 (2.3)	0.3144
Incision length (cm)	3 (2-5)	4 (3-7)	0.0001
Harvested lymph nodes	22 (5-54)	21 (2-60)	0.8896
Proximal margin (mm)	80 (20-250)	100 (35-260)	0.2741
Distal margin (mm)	100 (40-190)	80 (35-270)	0.0071
Time to first pass gas (d)	1 (1-4)	2 (1-5)	0.0312
Time to first stool (d)	2 (1-6)	3 (1-8)	0.0484
Time to resumption of oral intake (d)	3 (2-31)	3 (2-22)	0.9151
Number of analgesics used (count)	3 (0-13)	2 (0-16)	0.1503
Number of days on antibiotics (d)	1 (1-40)	1 (1-16)	0.7283
Duration of postoperative hospitalization (d)	7 (7-44)	9 (6-28)	0.3200
Total complications, n (%)			0.3132
CD Grade 1	2 (4.7)	3 (7.1)
CD Grade 2	5 (11.9)	8 (19.0)
CD Grade 3	5 (11.9)	1 (2.3)
Superficial/deep SSI	3 (7.1)	3 (7.1)	1.0000
Organ/space SSI	4 (9.5)	2 (4.7)	0.3968
Anastomotic leakage	4 (9.5)	2 (4.7)	0.3968

IA: Intracorporeal anastomosis; EA: Extracorporeal anastomosis; CD: Clavien-Dindo classification; SSI: Surgical site infection.

Table 3 Evaluation of peritoneal lavage fluid bacterial culture and cytology, n (%)

	IA (n = 39)	EA (n = 24)	P value
Bacterial culture			0.4143
Positive	22 (56.4)	11 (45.8)
Negative	17 (43.5)	13 (54.1)
Cytology
Class I	13 (33.3)	13 (54.1)	0.1029
Class II	26 (66.6)	11 (45.8)

IA: Intracorporeal anastomosis; EA: Extracorporeal anastomosis.

Table 4 Comparison of perioperative systemic inflammatory responses

	IA (n = 42)	EA (n = 42)	P value
WBC (count/mm3)
POD1	10200 (5600-21700)	8650 (5200-14300)	0.0068
POD4	5550 (3100-11800)	5500 (3600-13100)	0.4851
POD7	6250 (3200-13400)	5200 (2800-11900)	0.1157
CRP (mg/dL)
POD1	6.8 (1.8-12.3)	4.5 (0.9-12.1)	0.0011
POD4	6.2 (0.9-47.3)	5.2 (0.8-23.8)	0.2530
POD7	1.8 (0.1-24.2)	1.2 (0.2-8.0)	0.2675
Temperature (°C)
POD1	37.7 (36.9-39.9)	37.5 (36.4-38.4)	0.0079
POD4	36.5 (35.3-38.8)	36.4 (35.9-37.2)	0.2835
POD7	36.5 (35.3-38.8)	36.4 (35.9-37.2)	0.2835

IA: Intracorporeal anastomosis; EA: Extracorporeal anastomosis; WBC: White blood cell; CRP: C-reactive protein; POD: Postoperative day.

Table 5 Comparison of adjuvant chemotherapy

	IA (n = 14)	EA (n = 17)	P value
Time from surgery to adjuvant chemotherapy (d)	28 (19-40)	34 (20-48)	0.4005
Completion of adjuvant chemotherapy, n (%)	12 (85.7)	13 (76.4)	0.5168
Duration of adjuvant chemotherapy (d)	179 (63-211)	176 (88-231)	0.5908

IA: Intracorporeal anastomosis; EA: Extracorporeal anastomosis.

Table 6 Comparison of type of recurrence, n (%)

	IA (n = 42)	EA (n = 42)	P value
Overall recurrence	4 (9.5)	6 (14.2)	0.5004
Hematogenous metastasis	3 (7.1)	4 (9.5)	0.6930
Lymphatic metastasis	1 (2.3)	1 (2.3)	1.0000
Peritoneal metastasis	0 (0)	1 (2.3)	0.3144

IA: Intracorporeal anastomosis; EA: Extracorporeal anastomosis.