Análisis comparativo entre técnica anastomótica intracorporea y extracorpórea en la hemicolectomía derecha laparoscópica: estudio unicentrico

  • Título abreviado Análisis comparativo entre técnica anastomótica intracorporea y extracorpórea en la hemicolectomía derecha laparoscópica
  • Abbreviated title Comparative analysis between intracorporeal and extracorporeal anastomotic techniques in laparoscopic right hemicolectomy
  • Autores A. Vivas López
    D. Navarro Fajardo
    L. Lavin Montoya
    M. Labalde Martínez
    E. Rubio González
    O. García Villar
    C. Nevado García
    P. Peláez Torres
    F.J. García Borda
    E. Ferrero Herrero
  • Categoría Cirugía colorrectal
  • Fecha de recepción 29-03-2022
  • ISSN 3020-2655
  • Fecha de aceptación 17-05-2023
  • Páginas 7
  • Número Volumen 1:3

Análisis comparativo entre técnica anastomótica intracorporea y extracorpórea en la hemicolectomía derecha laparoscópica: estudio unicentrico

Comparative analysis between intracorporeal and extracorporeal anastomotic techniques in laparoscopic
right hemicolectomy: single-centric study

Alfredo Alejandro Vivas López*, David Navarro Fajardo*, Lucía Lavin Montoya*, María Labalde Martínez*,
Eduardo Enrique Rubio González*, Óscar García Villar*, Cristina Nevado García*, Pablo Peláez Torres*, 
Francisco Javier García Borda*, Eduardo Ferrero Herrero*

Servicio de Cirugía General, Aparato Digestivo y Trasplante de Órganos Abdominales, Unidad de Cirugía Colorrectal, Hospital Universitario 12 de Octubre, Madrid

DOI: 10.14679/2323
Resumen: 

Introducción: La técnica laparoscópica en el tratamiento quirúrgico de la neoplasia de colon derecho ya se ha instaurado como el abordaje de elección. Uno de los aspectos que sigue siendo objeto de discusión es la técnica empleada para la anastomosis, entre la técnica anastomótica extracorpórea (AEC) y la técnica intracorpórea (AIC), sin que aún se cuente con evidencia definitiva. Material y Métodos: Se analizaron de forma retrospectiva 189 pacientes sometidos a hemicolectomía derecha laparoscópica por causa tumoral, durante un periodo de 4 años (comprendido entre el 01/01/2018 y 01/01/2022), por cirujanos colorrectales de la unidad especializada de un único centro. Se compararon variables preoperatorias como el ASA, edad y comorbilidades de los pacientes y perioperatorias como tiempo operatorio, inicio de tránsito gastrointestinal, estancia postoperatoria, incidencia de fuga anastomótica, infección de sitio quirúrgico, y media de ganglios en la pieza postoperatoria. Resultados y discusión: De los 189 pacientes, en 142 se realizó AEC y en 47 AIC. Al comparar el tiempo operatorio total, la mediana fue 33 minutos mayor en el grupo con AIC. Con respecto al reinicio del Transito GI y la estancia postoperatoria se evidencio la disminución de 1 día en ambos indicadores al realizar la AIC. También se observó una aparente disminución de la infección del sitio quirúrgico y la dehiscencia anastomótica en el grupo AIC, pero sin llegar a ser esta variación estadísticamente significativa, y con resultados oncológicos (numero de ganglios resecados) equivalentes en ambos grupos. Conclusión: La AIC se muestra en nuestra serie como una técnica segura y superior en términos de estancia postoperatoria, y similar en sus resultados oncológicos al compararla con la técnica AEC.
Palabras clave: Anastomosis intracorporea, hemicolectomia derecha laparoscopica, sutura barbada.

Abstract: 

Introduction: The laparoscopic technique in the surgical treatment of neoplasia of the right colon has already been established as the approach of choice. One of the aspects that continues to be the subject of discussion is the technique used for the anastomosis, between the extracorporeal anastomotic technique (ECA) and the intracorporeal technique (ICA), without definitive evidence yet. Material and Methods: 189 patients undergoing laparoscopic right hemicolectomy due to tumor were retrospectively analyzed during a period of 4 years (between 01/01/2018 and 01/01/2022), by colorectal surgeons of the specialized unit. from a single center. Preoperative variables. such as ASA, age and comorbidities of the patients and perioperative variables such as operative time, start of gastrointestinal transit, postoperative stay, incidence of anastomotic leak, surgical site infection, and mean number of nodes in the postoperative piece were compared. Results and discussion: ECA was performed in 142 and ICA in 47. When comparing total operative time, the median was 33 minutes longer in the ICA group. Regarding the restart of the GI transit and the postoperative stay, a decrease of 1 day was evidenced in both indicators when performing the ICA. An apparent decrease in surgical site infection and anastomotic leakage was also observed in the AIC group, but this variation was not statistically significant, and with equivalent oncological results (number of lymph nodes resected) in both groups. Conclusion: The ICA shown in our series as a safe and superior technique in terms of postoperative stay, and similar in its oncological results when compared to the ECA technique.
Key words: Intracorporeal anastomosis, laparoscopic right hemicolectomy, barbed suture. 

Bibliografía
      1. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J. et al.; Colon Cancer Laparoscopic or Open Resection Study Group. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009;10:44–52.
      2. Arezzo A, Passera R, Ferri V, Gonella F, Cirocchi R, Morino M.. Laparoscopic right colectomy reduces short-term mortality and morbidity. Results of a systematic review and meta-analysis. Int J Colorectal Dis 2015;30:1457–1472.
      3. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F. et al.; Japan Clinical Oncology Group Colorectal Cancer Study Group. Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 2014;260:23–30.
      4. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ.. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2008; (2)CD003432.
      5. Tjandra JJ, Chan MK.. Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorect Dis 2006;8:375–388.
      6. Jian-Cheng T, Shu-Sheng W, Bo Z, Jian F, Liang Z.. Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer: an evaluation of short-term outcomes. Medicine (Baltimore) 2016;95:e5538.
      7. Carnuccio P, Jimeno J, Pares D.. Laparoscopic right colectomy: a systematic review and meta-analysis of observational studies comparing two types of anastomosis. Tech Coloproctol 2014;18:5–12.
      8. Shapiro R, Keler U, Segev L, Sarna S, Hatib K, Hazzan D.. Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis. Surg Endosc 2016;30:3823–3829.
      9. Lee KH, Ho J, Akmal Y, Nelson R, Pigazzi A.. Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer. Surg Endosc 2013;27:1986–1990.
      10. Ocaña J, Labalde-Martinez M, Vivas A, González L, Pelaez P, García-Borda J, Ferrero E. Step-by-step right colectomy and intracorporeal stapled side-to-side ileocolic anastomosis – a video vignette. Colorectal Dis. 2021 May;23(5):1291
      11. Emile SH, Elfeki H, Shalaby M, Sakr A, Bassuni M, Christensen P. et al. Intracorporeal versus extracorporeal anastomosis in minimally invasive right colectomy: an updated systematic review and meta-analysis. Tech Coloproctol 2019;23:1023–1035.
      12. Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N.. Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg 2014;149:177–184.
      13. Wu Q, Jin C, Hu T, Wei M, Wang Z.. Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech A 2017;27:348–357
      14. Milone M, Elmore U, Vignali A, Gennarelli N, Manigrasso M, Burati M. et al. Recovery after intracorporeal anastomosis in laparoscopic right hemicolectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 2018;403:1–10.
      15. Manigrasso M, Velotti N, Calculli F, Aprea G, Di Lauro K, Araimo E. et al. Barbed suture and gastrointestinal surgery. A retrospective analysis. Open Med (Wars) 2019;14:503–508.
      16. Zhang H, Sun N, Fu Y, Zhao C. Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: updated meta-analysis of randomized controlled trials. BJS Open. 2021;5(6):zrab133. doi:10.1093/bjsopen/zrab133
      17. Grams J, Tong W, Greenstein AJ, Salky B.. Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 2010;24:1886–1891.
      18. Iorio T, Blumberg D.. Totally intracorporeal laparoscopic colectomy (TILC) is associated with similar surgical outcomes in high and low operative risk patients. Surg Laparosc Endosc Percutan Tech 2013;23:154–158.
      19. Schwarz NT, Beer-Stolz D, Simmons RL, Bauer AJ.. Pathogenesis of paralytic ileus: intestinal manipulation opens a transient pathway between the intestinal lumen and the leukocytic infiltrate of the jejunal muscularis. Ann Surg 2002;235:31–40
      20. Marchesi F, Pinna F, Percalli L, Cecchini S, Ricco M, Costi R. et al. Totally laparoscopic right colectomy: theoretical and practical advantages over the laparo-assisted approach. J Laparoendosc Adv Surg Tech A 2013;23:418–424.