Laparoscopic Colectomy with Intracorporeal Anastomosis for Early-staged Colon Cancer

Fumihiko Fujita, MD, Yusuke Inoue, MD, Masahiko Nakayama, MD, Hiroko Kinoe, MD, Yuka Mine, MD, Shinichiro Kobayashi, MD, Kengo Kanetaka, MD, Kosho Yamanouchi, MD, Kazuma Kobayashi, MD, Tamotsu Kuroki, MD, Susumu Eguchi, MD. Nagasaki University Graduate School of Biomedical Sciences

INTRODUCTION: Conventional laparoscopic assisted surgery for colon cancer requires small skin incision for the extraction of the specimen and the ensuing anastomosis. For selected cases, we performed laparoscopic colon resection with an intracorporeal anastomosis in order to reduce incision. We presented our surgical technique and preliminary outcomes at SAGES meeting in 2012. At this time, we show our consecutive surgical outcomes until now.

METHODS AND PROCEDURES: We retrospectively collected the data, and analyzed the patients who underwent laparoscopic colectomy from February 2011 to July 2015. The intracorporeal anastomotic method was selectively performed only for early-stage colon cancer. The surgical technique was as follows. Four or five trocars were used, and the surgeon uses a 3 or 5 mm in diameter grasper with the left hand. First, the lesion lymph nodes are dissected. The lesion of the colon is transected using a linear stapler with adequate margins on both the oral and anal cut ends. Both ends of the intestines were over lapped for 6cm in the opposite direction. A laparoscopic linear cutting stapler is deployed through the bowel opening, to form a side-to-side isoperistaltic anastomosis. The enterotomy is closed with full thickness 3-0 vicryl continuous suture, and a seromuscular continuous suture is added. The resected specimen enclosed in a bag can be extracted through one of the trocar sites without laparotomy. We compared the results of the intracorporeal anastomosis with extracorporeal anastomosis, and analyzed the data for statistical significance.

RESULTS: Laparoscopic intracorporeal anastomosis was successfully performed for 20 consecutive patients (10 male and 10 female). The average age was 66.3 years, and the locations of the tumors were 8 in the sigmoid colon, 4 in the descending colon, 3 in the ascending colon, 3 in the cecum and 2 in the transverse colon. The average length of the operation was 223.6 minutes, and the estimated blood loss was 19.2 ml. There was no case that was converted to open surgery. Although one case was complicated by a wound infection, there were no major complications, such as anastomotic leakage or stricture. Intracorporeal anastomosis method was superior in estimated blood loss during the surgery to extracorporeal anastomosis method, and there was no statistical difference in the operation time between two groups.

CONCLUSIONS: The laparoscopic intracorporeal anastomotic method can be performed safely, and has the benefit of inducing minimal abdominal wounding and less blood loss in comparison to extracorporeal anastomosis.

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