Kasim Mirza, MD, Carey Wickham, MD, Andreas M Kaiser, MD, FACS, FASCRS. USC Colorectal Surgery
Introduction: Intracorporeal anastomosis (ICA) during minimally invasive colorectal resections (robotic/laparoscopic) has been thought to have advantages over extracorporeal anastomosis (ECA). It avoids exteriorization of the colon with room air exposure, traction, and manipulation in the resection and anastomosis phase and for placement of an EEA stapler anvil. We previously described the technique of a robotic single-dock intracorporeal anastomosis for rectosigmoid resections. The purpose of this study was to compare outcomes between robotic and laparoscopic ICA and ECA for sigmoid and low anterior rectal resections (LAR). We hypothesized that ICA was associated with decreased rates of ileus and LOS.
Methods: Patients who between 2015 and 2018 underwent a laparoscopic or robotic sigmoidectomy or LAR performed by a single surgeon at a tertiary referral center were retrospectively analyzed. Included were any minimally-invasive sigmoidectomy or LAR for benign or malignant disease with primary stoma-free anastomosis. ICA was defined as laparoscopic or single-dock robotic resection with intracorporeal colon resection and anvil placement, whereas ECA was defined as exteriorization of more than the specimen for resection, anvil placement, or anastomosis. Exclusion criteria included conversion from MIS to open surgery, creation of a stoma, or hand-sewn coloanal anastomosis.
The patients were grouped into ICA versus ECA. Data analyzed and compared included patient demographics, operative time, peri- and postoperative morbidity, and length of stay. Statistical analysis was performed on SAS software using 2-tailed t-test for continuous variables, and chi-squared or fisher exact test for categorical data.
Results: Of 64 patients identified, 40 met the criteria with 20 ICA (10 LARs and 10 sigmoidectomies) and 20 ECA (17 LARs and 3 sigmoidectomies). There were no significant differences between the groups for age, gender, ASA, or BMI. Average LOS was shorter in ICA (3.5 vs 5.3 days) without reaching statistical significance (p=0.088). While the rate of prolonged postoperative ileus showed no difference, overall complications were significantly higher in ECA (8/20 vs 2/20,=p=0.029). Responsible for this difference was a significantly lower complication rate after ICA for LARs when compared to ECA (p=0.026). Without reaching statistical significance, secondary outcomes such as operative time (254 vs 231 min,p=0.24) and leak rate (2/20, 0/20,p=0.49) favored ICA.
Conclusion: Minimally-invasive ICA was associated with favorable outcomes compared to ECA with significantly decreased overall post-operative complications and a trend to shorter LOS without an increase in operative time. ICA for rectosigmoid resections appears to offer an advantage and should be further evaluated
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95959
Program Number: P287
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster