Propensity Score Matching Analysis of Extracorporeal Versus Intracorporeal Anastomosis in Laparoscopic Colectomy for...

Background and objectives In recent years, laparoscopic colectomy (LC) has become the standard of care for treating colon cancer worldwide. LC has two main techniques: laparoscopic-assisted colectomy with extracorporeal anastomosis (LAC/EA) and total LC with intracorporeal anastomosis (TLC/IA). Each technique has its advantages and disadvantages. Our study aimed to compare outcomes between intracorporeal anastomosis and EA in LC for right colon cancer. Methods This was a retrospective cohort study comparing 140 patients who underwent total LC with IA group) and 177 patients who underwent laparoscopic-assisted right colectomy with EA group, based on patients' demographics and postoperative outcomes. Within postoperative outcomes, we also compared two subgroups: the extracorporeal hand-sewn (EHA) group (61 patients) and the extracorporeal stapler (ESA) group (116 patients) with the IA group. A propensity score matching analysis was performed to mitigate patient selection bias between the two groups and their subgroups. Results After propensity score matching, 131 patients in the EA group were compared with 131 in the IA group. In the subgroups, 107 patients in the ESA group and 56 in the EHA group were compared with the same number of patients in the IA group (107 and 56 patients, respectively). In the main groups, no statistically significant differences were observed in patients' demographics, tumor location, cancer stage, or type of surgery. The IA group had less intraoperative blood loss than the EA group (60.2 ± 29.9 ml vs. 72 ± 35.8 ml, p = 0.01), and the mean length of mini-laparotomy was shorter in the IA group (4.55 ± 0.75 cm vs. 6.21 ± 1.23 cm, p < 0.001). However, the mean operative time was significantly longer in the IA group (204 ± 38.5 min vs. 187 ± 41.8 min, p < 0.001). There was no significant difference in visual analogue scale (VAS) score (2.63 vs. 2.73, p = 0.22), time to flatus (2.53 vs. 2.75 days, p = 0.1), postoperative length of stay (7.05 vs. 7.44 days, p = 0.7), or rate of postoperative complications (7.6% vs. 13.7%, p = 0.1). The results of comparing the EHA and ESA groups with the IA group were similar. Conclusion Propensity score matching analysis revealed that the TLC/IA technique was superior to LAC/EA in terms of intraoperative blood loss and length of mini-laparotomy, although operative time was longer. Other outcomes, such as VAS, length of stay, time to flatus, and complication rate, showed no significant differences. Further randomized studies are required to draw definitive conclusions about the best anastomotic technique during laparoscopic right colectomy.