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Anastomose Intracorpórea Versus Extracorpórea na Hemicolectomia Direita Laparoscópica: A realidade da Unidade Local de Saúde Cova da Beira
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Abstract(s)
Introdução: Em Portugal, a neoplasia do cólon é o segundo tipo de cancro com maior
prevalência nacional. O tratamento curativo do cancro do cólon não metastático é a resseção
cirúrgica, sendo, atualmente, a hemicolectomia direita laparoscópica (HDL) considerada o goldstandard para resseção de tumores do cólon direito. No que respeita à anastomose ileocólica que
irá restituir o trânsito intestinal, a sua realização pode ser feita dentro (intracorpórea) ou fora da
cavidade abdominal (extracorpórea), não havendo ainda o consenso sobre a melhor opção
cirúrgica.
Objetivo: Comparar as técnicas de anastomose intracorpórea (AI) e extracorpórea (AE) na
HDL, através da avaliação de outcomes pós-operatórios na abordagem terapêutica de lesões do
cólon direito, tendo em consideração a população tratada na Unidade Local de Saúde (ULS)
Cova da Beira.
Métodos: Estudo retrospetivo baseado na recolha, análise e comparação de dados cirúrgicos de
pacientes com idade igual ou superior a 18 anos, com lesões do cólon direito, submetidos a
hemicolectomia direita laparoscópica nos últimos 10 anos (2013-2023) na ULS Cova da Beira,
em Portugal.
Resultados: Da amostra final de 99 HDL, o tipo de anastomose preferencialmente realizado
foi a AE, embora a AI tenha apresentado um crescimento de forma estatisticamente significativo
ao longo do tempo (p=0,002). Destacando os outcomes pós-operatórios, a duração do
internamento nos pacientes submetidos a HDL com AI foi significativamente menor que nos
submetidos a HDL com AE (7,39 ± 15,94 dias versus 13,44 ± 16,07 dias, p=0,012). Quanto ao
desenvolvimento de íleo pós-operatório, este apenas foi encontrado nos pacientes submetidos a
HDL com AE, o que torna os resultados clinicamente relevantes, mas a diferença observada não
é estatisticamente significativa (p=0,057). As complicações associadas à anastomose foram
substancialmente mais prevalentes no caso de anastomose extracorpórea, destacando-se a
infeção da ferida operatória (p=0,002). Adicionalmente, as “outras complicações” –
salientando-se a pneumonia, a infeção do trato urinário e a sépsis – predominam quase
exclusivamente nos pacientes submetidos a HDL com AE (p=0,003). A significância global
(p<0,001) do local de incisão para remoção da peça cirúrgica pode ser um fator importante para
a ocorrência de infeções da ferida operatória e de hérnias incisionais, sendo mais evidente na
incisão subcostal direita e mediana, respetivamente. Não se encontraram diferenças
significativas no tempo de recuperação intestinal, na dor pós-operatória, na duração da HDL, na
necessidade de reintervenção cirúrgica, nas complicações e mortalidade intraoperatórias, na mortalidade hospitalar, no reinternamento e mortalidade a 30 dias e na sobrevida a 1 ano das
duas intervenções em estudo.
Conclusão: Na hemicolectomia direita laparoscópica, a adoção de uma anastomose
intracorpórea apresenta vantagens, como um menor tempo de internamento e uma redução das
complicações pós-operatórias, comparativamente com a anastomose extracorpórea. Apesar de
ambos os tipos de anastomose se terem demostrado seguros e eficazes, considera-se que a
técnica mais vantajosa, tendo em consideração a população com lesões do cólon direito tratada
na Unidade Local de Saúde Cova da Beira, é a anastomose intracorpórea.
Introduction: In Portugal, colon cancer is the second most prevalent type of cancer nationwide. The curative treatment for non-metastatic colon cancer is surgical resection, with laparoscopic right hemicolectomy (RHC) currently considered the gold standard for the resection of right colon tumors. Regarding the ileocolic anastomosis that restores intestinal continuity, it can be performed either inside (intracorporeal) or outside (extracorporeal) the abdominal cavity, with no definitive consensus on the superior surgical approach. Objective: To compare intracorporeal (IA) and extracorporeal (EA) anastomosis techniques in RHC by evaluating postoperative outcomes in the therapeutic management of right colon lesions, considering the population treated at the Local Health Unit (ULS) of Cova da Beira. Methods: A retrospective study based on the collection, analysis, and comparison of surgical data from patients aged 18 years or older with right colon lesions who underwent laparoscopic right hemicolectomy over the past 10 years (2013–2023) at ULS Cova da Beira, Portugal. Results: From the final sample of 99 RHCs, the preferred type of anastomosis performed was EA, although IA showed a statistically significant increase over time (p=0.002). Regarding postoperative outcomes, the length of hospital stay for patients undergoing RHC with IA was significantly shorter than for those undergoing RHC with EA (7.39 ± 15.94 days vs. 13.44 ± 16.07 days, p=0.012). As for the development of postoperative ileus, this was observed only in patients who underwent RHC with EA, making the results clinically relevant, although the observed difference was not statistically significant (p=0.057). Anastomosis-related complications were substantially more prevalent in extracorporeal anastomosis, particularly surgical site infection (p=0.002). Additionally, “other complications”— notably pneumonia, urinary tract infection, and sepsis — were found almost exclusively in patients who underwent RHC with EA (p=0.003). The overall significance (p<0.001) of the incision site for specimen extraction may be an important factor in the occurrence of surgical site infections and incisional hernias, being more evident in right subcostal and midline incisions, respectively. No significant differences were found in intestinal recovery time, postoperative pain, duration of RHC, need for surgical reintervention, intraoperative complications and mortality, in-hospital mortality, 30-day readmission and mortality, or 1-year survival between the two approaches studied. Conclusion: In laparoscopic right hemicolectomy, intracorporeal anastomosis offers advantages such as shorter hospital stay and reduced postoperative complications compared to extracorporeal anastomosis. The incision site for specimen removal appears to significantly impact the risk of incisional hernias and surgical site infections, warranting further investigation in future studies. In conclusion, while both anastomosis techniques are safe and effective, intracorporeal anastomosis is considered the most advantageous technique for laparoscopic right hemicolectomy in the population with right colon cancer treated at ULS Cova da Beira.
Introduction: In Portugal, colon cancer is the second most prevalent type of cancer nationwide. The curative treatment for non-metastatic colon cancer is surgical resection, with laparoscopic right hemicolectomy (RHC) currently considered the gold standard for the resection of right colon tumors. Regarding the ileocolic anastomosis that restores intestinal continuity, it can be performed either inside (intracorporeal) or outside (extracorporeal) the abdominal cavity, with no definitive consensus on the superior surgical approach. Objective: To compare intracorporeal (IA) and extracorporeal (EA) anastomosis techniques in RHC by evaluating postoperative outcomes in the therapeutic management of right colon lesions, considering the population treated at the Local Health Unit (ULS) of Cova da Beira. Methods: A retrospective study based on the collection, analysis, and comparison of surgical data from patients aged 18 years or older with right colon lesions who underwent laparoscopic right hemicolectomy over the past 10 years (2013–2023) at ULS Cova da Beira, Portugal. Results: From the final sample of 99 RHCs, the preferred type of anastomosis performed was EA, although IA showed a statistically significant increase over time (p=0.002). Regarding postoperative outcomes, the length of hospital stay for patients undergoing RHC with IA was significantly shorter than for those undergoing RHC with EA (7.39 ± 15.94 days vs. 13.44 ± 16.07 days, p=0.012). As for the development of postoperative ileus, this was observed only in patients who underwent RHC with EA, making the results clinically relevant, although the observed difference was not statistically significant (p=0.057). Anastomosis-related complications were substantially more prevalent in extracorporeal anastomosis, particularly surgical site infection (p=0.002). Additionally, “other complications”— notably pneumonia, urinary tract infection, and sepsis — were found almost exclusively in patients who underwent RHC with EA (p=0.003). The overall significance (p<0.001) of the incision site for specimen extraction may be an important factor in the occurrence of surgical site infections and incisional hernias, being more evident in right subcostal and midline incisions, respectively. No significant differences were found in intestinal recovery time, postoperative pain, duration of RHC, need for surgical reintervention, intraoperative complications and mortality, in-hospital mortality, 30-day readmission and mortality, or 1-year survival between the two approaches studied. Conclusion: In laparoscopic right hemicolectomy, intracorporeal anastomosis offers advantages such as shorter hospital stay and reduced postoperative complications compared to extracorporeal anastomosis. The incision site for specimen removal appears to significantly impact the risk of incisional hernias and surgical site infections, warranting further investigation in future studies. In conclusion, while both anastomosis techniques are safe and effective, intracorporeal anastomosis is considered the most advantageous technique for laparoscopic right hemicolectomy in the population with right colon cancer treated at ULS Cova da Beira.
Description
Keywords
Anastomose Extracorpórea Anastomose Intracorpórea Complicações Hemicolectomia Direita Laparoscópica