Intracorporeal versus Extracorporeal Technique in Laparoscopic Left-sided Colectomy for Colon Cancer: A Prospective Cohort Study

Abstract

A BSTRACT Evidence regarding intracorporeal techniques in laparoscopic left-sided colectomy remains limited compared with right-sided colectomy despite potential advantages in postoperative recovery and minimally invasive specimen extraction. The aim of this study was to compare short-term operative, postoperative, and pathological outcomes between intracorporeal and extracorporeal techniques in laparoscopic left-sided colectomy for colon cancer. This was a prospective observational cohort study conducted at Sohag University Hospitals. A total of 108 patients undergoing laparoscopic left-sided colectomy for colon cancer between July 2021 and December 2024 were included. Patients were allocated to intracorporeal (IA, n = 50) or extracorporeal (EA, n = 58) technique groups according to surgeon preference and intraoperative considerations. Operative outcomes, postoperative recovery, complications, and pathological outcomes were evaluated. Comparative statistical analysis and multivariable regression analysis were performed to adjust for potential confounding variables. The IA group demonstrated significantly shorter extraction incision length compared with the EA group (5.54 ± 0.82 cm vs. 7.74 ± 1.01 cm, P < 0.001). Postoperative recovery was significantly improved in the IA group, including earlier oral feeding, earlier passage of flatus, and shorter hospital stay (all P < 0.001). Minor intraoperative bowel injuries were more frequent in the IA group and consisted predominantly of serosal tears repaired intraoperatively without postoperative sequelae. Anastomotic leak and postoperative complication rates were comparable between the groups. After multivariable adjustment, intracorporeal technique remained independently associated with shorter hospital stay and earlier return of bowel function. Intracorporeal technique in laparoscopic left-sided colectomy was associated with improved postoperative recovery and shorter hospital stay without compromising short-term oncological adequacy.