Does Intracorporeal Anastomosis Decrease the Rate of Surgical Site Infection in Laparoscopic Colon Cancer Surgery?

Objective: This study aimed to compare the surgical site infection (SSI) rates between intracorporeal anastomosis (ICA) and extracorporeal anastomosis (ECA). Summary of background data: Laparoscopic surgery is recommended for colonic malignancies because of its superior clinical outcomes and comparable oncologic results. Laparoscopic colectomy with ICA has the advantages of incision length and free extraction site choice. However, ICA may be associated with a risk of SSI due to enterotomy inside the abdominal cavity. Methods: We retrospectively analyzed patients with colon cancer who underwent radical surgery at Korea University Ansan Hospital between January 2017 and June 2020. We compared the SSI rates and other clinical variables between the ICA and ECA groups. Results: Of the 502 patients who underwent radical surgery for colorectal cancer during the study period, 234 were eligible for inclusion. ECA and ICAwere performed in 62.4% and 37.6% of patients, respectively. There were no statistically significant intergroup differences in clinicopathologic variables. The overall SSI rate did not differ between the groups (P = 0.801), but organ/space SSIs were more common in the ICA group than in the ECA group (P = 0.048). Conclusions: There was no significant difference in overall SSI or anastomotic leakage (AL) rates between the ICA and ECA groups, but the organ/space SSI rate was higher in the ICA group when AL cases were excluded. Further high-quality studies are needed to assess the risk of organ/space SSIs in the ICA after colon cancer surgery.