A totally mini-invasive approach for colorectal laparoscopic surgery

AIM：To study the short-term outcome of patients treated with laparoscopic right colectomy and how intracorporeal anastomosis has improved the outcome.METHODS：We retrospectively examined all patients affected by colorectal cancer who underwent a laparoscopic right colectomy between January 2006 and December 2010 in our department.Our evaluation criteria were：diagnosis of colorectal carcinoma at presurgical biopsy,elective surgery,and the same surgeon.We excluded：emergency surgery,conversions from laparotomic colectomy,and other surgeons.The endpoints we examined were：surgical time,number of lymph nodes removed,length of stay（removal of nasogastric tube,bowel movements,gas evacuation,solid and liquid feeding,hospitalization）,and major complications.Seventy-two patients were divided into two groups：intracorporeal anastomosis（39 patients）and extracorporeal anastomosis（33 patients）.RESULTS：Significant differences were observed between intracorporeal vs extracorporeal anastomosis,respectively,for surgical times（186.8 min vs 184.1 min,P 〈 0.001）,time to resumption of gas evacuation（3 d vs 3.5 d,P 〈 0.001）,days until resumption of bowel movements（3.8 d vs 4.9 d,P 〈 0.001）,days until resumption of liquid diet（3.5 d vs 4.5 d,P 〈 0.001）,days until resuming a solid diet（4.6 d vs 5.7 d,P 〈 0.001）,and total hospitalization duration（7.4 d vs 8.5 d,P 〈 0.001）.In the intracorporeal group,on average,19 positive lymph nodes were removed;in the extracorporeal group,on average,14 were removed P 〈 0.001）.Thus,intracorporeal anastomosis for right laparoscopic colectomy improved patient outcome by providing faster recovery of nutrition,faster recovery of intestinal function,and shorter hospitalization than extracorporeal anastomosis.CONCLUSION：Short-term outcomes favor intracorporeal anastomosis,confirming that a less traumatic surgical approach improves patient outcome.