关键词: 腹腔镜右半结肠切除术, 腹腔内吻合, 腹腔外吻合, 标本, 术后并发症

Abstract: To investigate the effects of different specimen extraction locations on the short-term outcomes of patients who underwent intracorporeal or extracorporeal anastomosis in laparoscopic right hemicolectomy. Methods    A retrospective analysis was conducted based on the clinical data of 728 patients who underwent laparoscopic right hemicolectomy at the Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital between January 2016 and June 2023, of whom 474 patients underwent extracorporeal anastomosis and 254 patients underwent intracorporeal anastomosis. Before August 2021, the specimen was removed through a protected incision extended from main operation trocar on the upper left abdomen, among which there were 359 cases of extracorporeal anastomosis and 154 cases of intracorporeal anastomosis. After August 2021, the specimen was removed through a protected incision extended from observation Trocar on the mid-lower abdomen, among which there were 115 cases of extracorporeal anastomosis and 100 cases of intracorporeal anastomosis. The propensity score inverse probability weighting method (IPTW) was used to balance the baseline characteristics between groups. When the specimen was extracted from different sites, the short-term outcomes of intracorporeal and extracorporeal anastomosis were compared. Results    (1) When the upper left abdomen was chosen as the specimen extraction site, patients from intracorporeal anastomosis group had a prolonged operation time and an increased incidence of overall complications, abdominal infection, abdominal infection (excluding anastomotic leakage), and wound infection were observed  than patients from extracorporeal anastomosis group, with a significant difference (P<0.05). (2) When the mid-lower abdomen was chosen as the specimen extraction site, patients from intracorporeal anastomosis group had more dissected lymph nodes, a longer operation time, and a shorter postoperative hospital stay than patients from extracorporeal anastomosis group, with a significant difference (P<0.05), while there was no significant difference in the incidence of overall complications, Clavien-Dindo grade Ⅲ-Ⅳ complications, abdominal infection (both with or without anastomotic leakage), anastomotic leakage, and wound infection between the two groups (P>0.05). (3) In the intracorporeal anastomosis group, patients undergoing modified surgery had a shorter operation time, less intraoperative bleeding, and a decreased incidence of overall complications and wound infection than patients undergoing unmodified surgery, with a significant difference (P<0.05). Conclusion    When the specimen extraction site in laparoscopic right hemicolectomy was modified from the upper left abdomen main operation site to the mid-lower abdomen observation site, the rate of wound infection in intracorporeal anastomosis was significantly decreased, suggesting avoid choosing the main operation site as the specimen extraction site to decrease the risk of wound infection.

Key words: laparoscopic right hemicolectomy, intracorporeal anastomosis, extracorporeal anastomosis, specimen, postoperative complications