Comparative outcomes of intracorporeal and extracorporeal anastomosis following laparoscopic colectomy in patients with obesity with Colon cancer

Purpose: Laparoscopic surgery with intracorporeal anastomosis (IA) is a well-established procedure in colorectal cancer surgery. Nonetheless, its feasibility in patients with obesity remains unclear. This study aimed to evaluate the short-term and medium-term outcomes of IA to extracorporeal anastomosis (EA) among a cohort of patients with general obesity treated at a single teaching hospital. Methods: The study included patients with obesity who underwent laparoscopic radical colectomy with primary bowel anastomosis for colon cancer between September 2007 and December 2021. Patients were split into two groups according to the method of anastomosis used: EA or IA. We evaluated various surgical outcomes, namely postoperative complications, recovery metrics, pain intensity, and 3-year survival rates. Results: A total of 355 patients with obesity with colorectal cancer were enrolled in the study. 150 and 205 patients were in the IA and EA groups, respectively. The IA group demonstrated faster bowel recovery, faster resumption of diet, and shorter hospital stays compared with the EA group. Additionally, IA yielded specimens with longer lengths and larger safety margins relative to the tumor. The EA group exhibited a significantly higher overall rate of postoperative complications, most notably postoperative ileus. However, the 3-year oncological outcomes were similar between the IA and EA groups. Conclusion: The study revealed that in patients with obesity, IA resulted in faster bowel function recovery, shorter hospital stays, and fewer complications. Furthermore, IA produced better pathological outcomes, characterized by longer specimen lengths and wider safety margins, without compromising 3-year overall and disease-free survival rates. Thus, IA is a safe and feasible anastomosis technique for patients with obesity undergoing laparoscopic colectomy for colorectal cancer.