Is intraperitoneal isoperistaltic side-to-side anastomosis a safe surgical procedure in radical colon cancer surgery

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.

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

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.

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.

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