Effect and safety of parallel and cross-to-overlap anastomosis in 3D laparoscopic radical colon cancer
Objective To compare the effect and safety of parallel and cross-to-overlap anastomosis(PCOA)and end-to-side anastomosis during gastrointestinal tract reconstruction in 3D laparoscopic radical resection of colon cancer,and to explore the value of PCOA in the surgical treatment of colon cancer.Methods From October 2017 to October 2022,201 patients with colon cancer underwent 3D laparoscopic radical resection of colon cancer in Henan Provincial People's Hospital,among whom 153 patients were performed PCOA(PCOA group)and 48 patients were subjected to end-to-side anastomosis(end-to-side anastomosis group)in gastrointestinal tract reconstruction.The surgery time,anastomosis time and blood loss during surgery,number of lymph node dissection,time to first flatus,oral fluid-food intake and off-bed activity after surgery,length of postsurgical hospital stay,and postsurgical complications(anastomotic leakage,intestinal obstruction,incision infection,pulmonary infection,etc.)were recorded in two groups.The follow-up was conducted till March 2024 to record the survival and tumor recurrence and metastasis,and the overall survival and disease-free survival rates were calculated.Results The intrasurgical anastomosis time,the time to first postsurgical flatus and the length of postsurgical hospital stay were shorter in the PCOA group[(23.2±4.4)min,(2.1±0.9)d,(5.1±1.2)d]than those in the end-to-side anastomosis group[(31.8±6.1)min,(2.7±1.1)d,(6.4±1.1)d](t=8.470,P＜0.001;t=4.335,P＜0.001;t=9.621,P＜0.001),and there were no significant differences in the surgery time,intrasurgical blood loss,number of lymph node dissection,time to first oral fluid-food intake and time to first off-bed activity after surgery between the PCOA group[(143.0±47.0)min,(45.1±15.4)mL,24.0±9.0,(4.3±1.6)d,1.6(1.2,1.9)d]and the end-to-side anastomosis group[(149.3±45.7)min,(46.3±15.6)mL,23.7±8.7,(4.5±1.4)d,1.6(1.3,1.9)d](t=-0.283 to 1.119,Z=-0.530;all P values＞0.05).The postsurgical complications occurred in 6 cases in the PCOA group,including anastomotic leakage in 1 case,intestinal obstruction in 2 cases,incision infection in 2 cases and pulmonary infection in 1 case,and occurred in 7 cases in the end-to-side anastomosis group,including intestinal obstruction in 5 cases and incision infection in 2 cases.The incidence of postsurgical complications was lower in the PCOA group(3.9％)than that in the end-to-side anastomosis group(14.6％)(X2=5.216,P=0.022).In the PCOA group,128 patients fulfilled the follow-up survey,among whom 2 died,6 developed distant metastasis,and 120 were generally in good condition.In the end-to-side anastomosis group,43 patients fulfilled the follow-up survey,among whom 1 died,3 developed distant metastasis,and 39 were generally in good condition.There were no significant differences in the overall survival and disease-free survival rates between the PCOA group(98.4％,93.8％)and the end-to-side anastomosis group(97.7％,90.7％)(x2=0.294,P=0.588;x2=1.419,P=0.232).Conclusion Compared with traditional end-to-side anastomosis,PCOA in gastrointestinal tract reconstruction during 3D laparoscopic radical resection of colon cancer has higher anastomosis efficiency,faster postsurgical intestinal function recovery,lower incidence of postsurgical complications,and no impact on postsurgical survival rate,and it is safe and feasible.
colon cancer3D laparoscopyradical resection of colon cancergastrointestinal tract reconstructionparallel and cross-to-overlap anastomosisend-to-side anastomosis
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