Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers
Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers
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DOI：
10.1007/s00464-014-3950-7
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发表时间：
2015-08-01
影响因子：
3.1
通讯作者：
Milone, Francesco
中科院分区：
文献类型：
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作者：
Milone, Marco;Elmore, Ugo;Milone, Francesco
尽管目前从短期和长期的结果以及肿瘤的根治性来看，腹腔镜右结肠切除术被认为是可行和有效的手术，但只有少数外科医生进行腹腔镜右结肠切除术，而且在绝大多数情况下，该技术是通过体外吻合进行的。目前的文献未能解决腹腔镜右结肠切除术后体内吻合与体外吻合的争议。设计了一项多中心病例对照研究，包括286例行腹腔镜右半结肠切除术合并orporeal内吻合（IA）的患者与226例行腹腔镜右半结肠切除术合并orporeal外吻合（EA）的匹配患者。两组在年龄、性别、BMI和ASA评分方面无显著差异。根据AJCC/UICC TNM，手术后病史、肿瘤定位和疾病分期也相似。虽然类似肿瘤的表达数量的淋巴结收获(25.7 + / - 10.7 IA集团与EA组24.8 + / - 8.7;p = 0.3),以及类似的手术时间(166 + / - 43.7分钟IA组和157.5 + / - 67.2分钟在EA组)已经注册,时间屁intracorporeal吻合后低统计(40.8 + / - 24.3 h TLRC组和55.2 + / - 19.2 h LARC组;p < 0.001)腹腔镜结肠切除术合并肠内吻合术术后并发症发生率较低（OR 0.65, 95% CI 0.44, 0.95, p = 0.027）。然而，当根据克拉维恩分类进行分层时，在较轻的（I级和II级）并发症（OR 0.63, 95% CI 0.42, 0.94, p = 0.025）中一致证实了差异，但在III级，IV级和V级并发症中没有差异（OR 1.015, 95% CI 0.64, 1.6, p = 0.95）。我们的结果令人鼓舞，认为腹腔内入路是腹腔镜右结肠切除术后更好的吻合方式。本研究清楚地为随机临床试验提供了基本原理，这将有助于得出明确的结论。
Although nowadays considered as feasible and effective surgery in terms of short- and long-term results and oncological radicality, laparoscopic right colectomy is performed by a small number of surgeons, and in the vast majority of cases, this technique was performed with an extracorporeal anastomosis. Current literature failed to solve the controversies between intracorporeal and extracorporeal anastomosis after laparoscopic right colectomy.A multicenter case-controlled study has been designed, including 286 patients who underwent laparoscopic right hemicolectomy with intracorporeal anastomosis (IA) compared with 226 matched patients who underwent laparoscopic right hemicolectomy with extracorporeal anastomosis (EA).There was no significant difference in terms of age, sex, BMI, and ASA score between the two groups. Surgical post history, tumor localization, and stage of disease according to AJCC/UICC TNM were similar too. Although similar oncologic radicality in term of number of lymph nodes harvested (25.7 +/- A 10.7 of IA group vs. 24.8 +/- A 8.7 of EA group; p = 0.3), as well as similar operative time (166 +/- A 43.7 min. in IA group vs. 157.5 +/- A 67.2 min in EA group) have been registered, time to flatus was statistically lower after intracorporeal anastomosis (40.8 +/- A 24.3 h in TLRC group vs. 55.2 +/- A 19.2 h in LARC group; p < 0.001) Laparoscopic colectomy with intracorporeal anastomosis was associated with a lower rate of post-operative complications (OR 0.65, 95 % CI 0.44, 0.95, p = 0.027). However, when stratifying according to clavien classification, the difference was consistently confirmed for less severe (class I and II) complications (OR 0.63, 95 % CI 0.42, 0.94, p = 0.025), but not for class III, IV, and V complications (OR 1.015, 95 % CI 0.64, 1.6, p = 0.95).Our results are encouraging to consider the intracorporeally approach the better way to fashion the anastomosis after laparoscopic right colectomy. This study clearly provides the rationale for a randomized clinical trial, which would be useful to give definitive conclusion.