Intracorporeal vs. extracorporeal anastomosis in laparoscopic right hemicolectomy for cancer

Abstract

Background: Surgery remains the most definitive treatment for colon cancer. Laparoscopic procedure has been developed as a better alternative to the open technique. After the bowel resection, its reconstruction can be performed in an intracorporeal or an extracorporeal way. The majority of right laparoscopic colectomies continue to be performed with an extracorporeal anastomosis due to inherent technical difficulties in acquiring advanced laparoscopic suturing skills. Few studies have been carried out comparing the differences between the two techniques, and their results described better outcomes in favour of the intracorporeal way, with a reduction of short-term morbidity and a decrease of the length of stay, suggesting faster recovery. However, all of them were retrospective and controversies are still unsolved. Objective: The aim of this study is to evaluate the recovery of the bowel function after two different techniques of anastomosis in the treatment of right colon cancer. We will also evaluate the early complications after surgery and the time of hospitalization. Design: A randomized, single-blinded, controlled clinical trial which will be carried out in Hospital Universitari Josep Trueta within the General Surgery Service from April 2017 until 2021. Method: 158 patients with right colon cancer will be recruited with a non-probabilistic, consecutive method. They will be randomly assigned to one of the treatment groups, either extracorporeal anastomotic technique or intracorporeal anastomotic one. Non parametric U-Mann Whitney test or Student-T test will be used for the statistical analysis of the primary and one of the secondary endpoints, depending if they are or they are not normally distributed. The last endpoint will be analysed with a chi-square test, and a confidence interval of 95% will be assumed