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Surgical site infection after intracorporeal and extracorporeal anastomosis in laparoscopic left colectomy for colon cancer: a multicenter propensity score-matched cohort study

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Abstract

Background

Intracorporeal anastomosis (IA) is associated with reduced surgical site infection (SSI) and other postoperative complications in laparoscopic right colectomy (LRC). However, evidence is inadequate for IA in laparoscopic left colectomy (LLC). This study aimed to determine the effect of IA and extracorporeal anastomosis (EA) on SSI and other short-term postoperative complications in LLC.

Methods

In this retrospective multicenter propensity score-matched (PSM) cohort study, we enrolled consecutive patients who underwent LLC with IA (TLLC/IA) and laparoscopic-assisted left colectomy with EA (LALC/EA) at two medical centers between January 2015 and September 2021. Propensity score matching with a 1:2 ratio was employed. The primary outcome was SSI occurrence. Secondary outcomes were operating time, intraoperative hemorrhage, other postoperative complications, and pathological outcomes.

Results

Overall, 574 and 99 patients received LALC/EA and TLLC/IA, respectively. After PSM, 84 patients with TLLC/IA were matched with 141 patients with LALC/EA. Thirty patients (13.3%) patients experienced SSI (17.0% in LALC/EA vs 7.1% in TLLC/IA). IA was associated with a reduced risk of overall SSI and superficial/deep SSI compared with EA after PSM, with OR of 0.375 (95% CI, 0.147–0.959, P = 0.041). and 0.148 (95% CI, 0.034–0.648, P = 0.011), respectively. Multivariate analysis of unmatched patients indicated similar results. In the analysis of secondary outcomes, LALC/EA may have a shorter operating time (absolute mean difference − 13.41 [95% CI, − 23.76 to − 3.06], P = 0.002) and a higher risk of intraoperative hemorrhage (absolute risk difference 4.96 [95% CI, − 0.09 to 9.89], P = 0.048).

Conclusions

IA in LLC is associated with a reduced risk of overall SSI and superficial/deep SSI. However, it may require a longer operating time.

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Acknowledgements

We thank Yanhua Wu from the Clinical Research Department of the First Hospital of Jilin University for providing statistical guidance in this study.

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  1. Yuchen Guo and Kexuan Li are first co-authors with equal contribution.

Authors and Affiliations

  1. Department of Gastrocolorectal Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, 130021, China

    Yuchen Guo, Liang He, Weihua Tong, Yan Chen & Quan Wang

  2. Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China

    Kexuan Li, Bin Wu, Guole Lin, Huizhong Qiu, Lai Xu & Yi Xiao

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  1. Yuchen Guo
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Correspondence to Yi Xiao or Quan Wang.

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Dr. Yuchen Guo, Ms. Kexuan Li, Prof. Liang He, Prof. Weihua Tong, Dr. Yan Chen, Prof. Bin Wu, Prof. Guole Lin, Prof. Huizhong Qiu, Prof. Lai Xu, Prof. Yi Xiao, and Prof. Quan Wang have no conflicts of interest or financial ties to disclose.

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Guo, Y., Li, K., He, L. et al. Surgical site infection after intracorporeal and extracorporeal anastomosis in laparoscopic left colectomy for colon cancer: a multicenter propensity score-matched cohort study. Surg Endosc 37, 6208–6219 (2023). https://doi.org/10.1007/s00464-023-10093-y

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