Comparison of a Novel Intracorporeal Anastomosis Versus Extracorporeal Anastomosis for Colon Cancer: A Propensity Score-Weighted, Prospective Idea, Development, Exploration, Assessment, Long-term Stage 2b Cohort Study.
TL;DR
The U-tied functional end-to-end anastomosis is a safe, feasible, and cost-neutral intracorporeal technique that reduces surgical trauma, alleviates early pain, and accelerates recovery.
Abstract
Background
Intracorporeal anastomosis benefits are often offset by high costs and technical complexity.
Objective
To evaluate the safety, efficacy, and cost-neutrality of a novel U-tied functional end-to-end anastomosis v. conventional laparoscopic-assisted colectomy.
Design
Prospective cohort study following the Idea, Development, Exploration, Assessment, Long-term follow-up Stage 2b framework, using inverse probability of treatment weighting. SETTINGS Single tertiary referral hospital. PATIENTS Patients undergoing elective radical colectomy for colon cancer (May 2023 to December 2025).
Interventions
Intracorporeal U-tied functional end-to-end anastomosis v. conventional extracorporeal anastomosis. MAIN OUTCOME MEASURES Overall 30-day postoperative complications, operative metrics, recovery indicators, postoperative pain, and hospital costs.
Results
Of 461 patients, 294 underwent extracorporeal and 167 received U-tied anastomosis. After weighting, baseline covariates were balanced. Thirty-day complication rates were comparable between U-tied and conventional groups (10.8 vs 11.3%, p = 0.907), a finding consistently supported by sensitivity analyses (all p > 0.05). However, this nonsignificant result should be interpreted cautiously as absence of evidence to detect a difference. Although the U-tied required longer anastomosis time (27.4 vs 22.4 min, p < 0.001), total operative times were comparable ( p = 0.172). The U-tied group showed significant advantages in shorter incisions (4.3 vs 8.9 cm), reduced blood loss, and earlier return of bowel function (flatus: 60.8 vs 80.4 hours; defecation: 73.9 vs 87.0 hours; all p < 0.001). Visual analogue scale (VAS) scores were significantly lower in the U-tied group on Pod 1 ( p < 0.001). Limitations: Single-center design and limited statistical power for rare complications.
Conclusions
The U-tied functional end-to-end anastomosis is a safe, feasible, and cost-neutral intracorporeal technique that reduces surgical trauma, alleviates early pain, and accelerates recovery. See Video Abstract.