Laparoscopic Right Colectomy with Intracorporeal Anatomosis for Colon Cancer: Surgical and Oncologic Outcomes in 52 Patients

Joyce Ho, MD, Yasir Akmal, MD, Alessio Pigazzi, MD PhD. City of Hope National Medical Center, Duarte, CA and Huntington Memorial Hospital, Pasadena, CA

Introduction
Laparoscopic colon surgery encompasses a variety of techniques ranging from hand-assisted laparoscopic surgery (HALS) to laparoscopic-assisted colectomy with extracorporeal anatomosis (LAC) to laparoscopic colectomy with intracorporeal anastomosis (LCIA). Data on technique-specific outcomes are lacking, especially for LCIA. Our objective was to elucidate the safety, efficacy, and oncologic outcomes of laparoscopic right colectomy with intracorporeal anatomosis (LRCIA) in patients with colon cancer.

Methods
The charts of all consented patients who underwent LRCIA at City of Hope National Medical Center and Huntington Memorial Hospital between 3/2005 and 6/2010 were retrospectively reviewed. Relevant data analyzed included patient demographics, operative parameters, complications, and recurrence.

Results
A total of 52 consecutive patients were identified. Forty-seven of the 52 patients had a diagnosis colon cancer. Median age was 69 years (43-90). Median operative time was 197 min (98-396). Median EBL was 75 ml (15-550). The median number of lymph node retrieval was 20 (8-48). Median hospital stay was 5 days (2-28). Overall morbidity was 46%. Post-operative ileus was the most common complication (19%). Three patients (6%) developed intraabdominal abscesses with no evidence of leak and one patient (2%) had an anastomotic leak. Of the 47 patients with colon cancer, histological staging revealed 13 patients had stage 0 disease, 10 had stage I, 6 had stage II, 14 had stage III, and 4 had stage IV disease. In addition to right colectomy, two patients underwent wedge resections for synchronous liver metastases, two patients had en-bloc resections with other organ(s), one patient had low anterior resection for synchronous rectal cancer, and one patient underwent oophorectomy for benign ovarian pathology. There were no conversions. Median follow-up was 9 months (0.5 to 48). Cancer recurrence occurred in 1 patient (2%). The 3 year overall survival is 71% and disease specific survival is 80%. The median survival has not been reached.

Conclusion
Laparoscopic right colectomy with intracorporeal anatomosis (LRCIA) is feasible and safe and can be performed in patients with colon cancer.