Extraction site hernia and short-term outcomes following intracorporeal versus extracorporeal anastomosis for robotic and laparoscopic right colectomy: a multi-center prospective trial

Background: Studies have shown outcomes advantages of intracorporeal compared to extracorporeal anastomosis during minimally invasive right colectomy that include less conversion to open, faster return of bowel function, and shorter hospital length of stay. The extracorporeal anastomosis and specimen extraction incision are often midline and may be associated with incisional hernias. The study aim was to determine if intracorporeal right colectomy is associated with fewer incisional hernias. Methods: This is the final data analysis for the ANastomotic COmparison in Right Colectomy (ANCOR) prospective multi-center study designed to compare laparoscopic- or robotic-assisted intracorporeal versus extracorporeal anastomoses in patients undergoing minimally invasive right colectomy for benign or malignant neoplasia. The primary outcome was the extraction site incisional hernia rate at 2 years. Secondary outcomes included hospital length of stay and short-term complications. Descriptive statistics [mean with standard deviation and median with interquartile range (IQR)] were applied using SAS 9.4. Results: 150 patients (30 laparoscopic and 120 robotic assisted) underwent intracorporeal anastomosis, and 150 patients (120 laparoscopic and 30 robotic assisted) underwent extracorporeal anastomosis. All extracorporeal specimen extraction sites were midline. Intracorporeal extraction sites were off-midline in 98.7%. At 2 years, extraction site hernias were significantly more common in the extracorporeal group (10.1% vs. 1.9%, p = 0.013), with only one hernia repaired in the intracorporeal group. The intracorporeal group had significantly fewer conversions to open (0% vs. 4.7%, p < 0.0001), shorter extraction site incisions (4.9 cm vs. 6.0 cm, p < 0.0001), shorter time to gastrointestinal recovery, shorter time to tolerating diet, shorter hospital length of stay (3.0 vs. 4.0 days, p < 0.0001), and longer operative times (207.5 min vs. 173.1 min, p < 0.0001). There were no significant differences between groups in postoperative complications and short-term oncologic outcomes. Conclusion: Intracorporeal anastomosis during minimally invasive right colectomy is associated with a lower rate of incisional hernias and other benefits compared to the extracorporeal approach. These data support continued training in and implementation of intracorporeal anastomotic techniques. Trial Registration: Clinicaltrials.gov identifier: NCT03312569.