Comparison of different anastomosis methods in laparoscopically assisted left hemicolectomy for colon cancer.

BACKGROUND: Left colon cancer surgery relies on laparoscopic hemicolectomy, with digestive tract reconstruction critical. End-to-side anastomosis (ESA) and side-to-side anastomosis (SSA) anastomoses are common, but their comparative outcomes, especially in splenic flexure handling and efficacy, need clarification. This study compares ESA and SSA to guide surgical practice. AIM: To compare the clinical outcomes of laparoscopically assisted left hemicolectomy with ESA and SSA. METHODS: A total of 334 patients were included, with 105 patients from the First Affiliated Hospital of Xiamen University and 229 patients from the First Affiliated Hospital of Fujian Medical University, between January 1, 2012, and May 31, 2020. The patients were divided into two groups: 146 cases in the ESA group and 188 cases in the SSA group. Clinical data from both groups were compared, and the survival prognosis was followed up. RESULTS: The operation time for the ESA group was significantly shorter than that of the SSA group (197.1 ± 57.7 minutes vs 218.6 ± 67.5 minutes, χ 2 = 4.298, P = 0.039). There were no significant differences between the two groups in intraoperative blood loss, postoperative pain score at 48 hours, time to first bowel movement, number of lymph nodes dissected, or postoperative complications such as anastomotic leakage, bleeding, stenosis. and adhesive intestinal obstruction at 6 months, 12 months, and 24 months (P > 0.05). Specifically, the incidence of complications like anastomotic leakage was 2.1% in the ESA group vs 4.3% in the SSA group (P = 0.264). The 5-year disease-free survival (DFS) rate was 66.4% for the ESA group and 63.9% for the SSA group (P = 0.693). There were no significant differences in the overall survival rate between the two groups. The incidence of splenic laceration was significantly higher in the SSA group (3.7% vs 0.7%, P = 0.018). Overall, the 5-year DFS was 66.4% for ESA and 63.9% for SSA, with no significant difference in survival between the groups (P = 0.693). CONCLUSION: Both laparoscopically assisted left hemicolectomy with ESA and SSA are feasible and offer comparable long-term outcomes. ESA may reduce the need for splenic flexure dissociation, particularly when the tumor is located at the descending colon or its junction with the sigmoid colon, and especially in obese patients, elderly individuals with multiple complications, or those with severe adhesions in the splenic flexure of the surgical field.