Value of different anastomoses in laparoscopic radical right hemicolectomy for right-sided colon cancer: retrospective study and literature review

Abstract

Background: This study aimed to analyze the safety of circular lateral anastomosis and cross-lateral anastomosis in laparoscopic radical resection of right-sided colon cancer.

Methods: From January 2018 to March 2021, 147 patients with right-sided colon cancer were admitted to the Department of General Surgery, Cancer Hospital, Zhengzhou University. The experimental group comprised patients with circular lateral anastomosis, whereas the control group comprised patients with cruciform lateral anastomosis. The general clinical data, intraoperative features, and postoperative results of the two groups were compared and analyzed.

Results: Both groups successfully underwent laparoscopic lateral ileocolic anastomosis, with significant differences in anastomotic leakage (χ²=4.520, P < 0.05). By contrast, body mass index (t = 1.568, P = 0.119), histological typing (χ² = 2.067, P = 0.559), intraoperative bleeding (t = 0.418, P = 0.677), and intestinal obstruction (χ² = 2.564, P = 0.109) were not significantly different between the groups (P > 0.05).

Conclusions: In laparoscopic-assisted radical hemicolectomy for right-sided colon cancer, the incidence of postoperative anastomotic leakage was lower with circular lateral anastomosis than with cross-lateral anastomosis, and circular lateral anastomosis was superior to cross-lateral anastomosis in terms of reducing the length of hospital stay and improving patients' postoperative quality of life.

Keywords: Anastomotic leak; Colon tumor; Lateral anastomosis; Right colon cancer.

Fig. 1

The procedure of two different anastomosis methods for right-sided colon cancer. A After excision of the mass, the small intestine and colonic stump were closed with a stapler. B The common opening formed by the two intestinal sites after closure, I and H, are the meeting points of the junction between the anastomotic nail and the stump. C To ensure a straight line between I and H points when closing the common stump of ileocolonic, and I and H are the starting and ending points, the interrupted suture method (approximately 5–7 stitches for lifting and fixation) is used between the starting and ending points. D All sutures were lifted, and the common stump was closed with a disposable linear stapler, with the common opening forming a horizontal line. E After closing the common opening, the anastomosis is annular at this time. F I and H points in the control group were close to or overlapped when the ileocolonic lateral anastomosis was performed. G After the closure of the common stump in the control group, the anastomosis had a cruciform shape