Intracorporeal colonic anastomosis leads to enhanced recovery and reduced morbidity rates compared to extracorporeal anastomosis: a retrospective cohort study of 331 colonic resections

Background: The intracorporeal anastomosis (IA) technique is increasingly adopted in colonic surgery due to possible enhanced patient recovery and reduced morbidity rates compared to the extracorporeal anastomosis (EA) technique. This study compared the IA versus EA techniques in an implementation phase regarding short-term morbidity and surgical efficacy in segmental colonic resections for various etiology. Method We performed a retrospective cohort study of consecutive patients from 2015–2020 using the IA or EA technique at a Danish colorectal center. Comparative outcomes of interest were surgical efficacy and short-term morbidity rates. An inverse probability of treatment weighting (IPTW) analysis of clinically relevant outcomes was conducted to explore potential baseline confounding. Results We included 331 patients, 287 in the IA group and 44 in the EA group. The following was recorded in the IA compared to the EA group: i) enhanced recovery rate resulting in; a shorter hospital stay (3.1 days (2.9–5.1) vs. 4.1 days (3.2–6.2), p = 0.008), ii) a lower conversion rate to open surgery (0% vs. 5%, p = 0.017), and iii) a reduction in overall medical complications (15% vs. 34%, p = 0.005). Supplementary logistic regression and adjusted IPTW analysis showed the IA group had a reduction in intraoperative blood loss (mean difference = -62.31 mL, p = 0.015) and Clavien-Dindo grade 1–2 medical complication rates (relative risk reduction (RRR) = 0.33, p = 0.000). Conclusion Employment of the IA technique in segmental colonic cancer surgery is safe, resulting in improved patient recovery and postoperative morbidity rates compared to the EA technique.