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Session: ePoster: Colon and Colorectal Cancer 15 (Mon115)

EP768 - Intracorporeal Anastomosis in Minimally Invasive Robot-Assisted Left-Sided Colon and Rectal Resections is Associated with Shorter Postoperative Length of Stay

Monday, May 12, 2025
1:36 PM – 1:41 PM PT

    ePoster Presenter(s)

  • Razmik Ghukasyan, MD, MBA

    Fellow Physician
    University of Pennsylvania
    Chesterbrook, PA, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • MB

    Mark Bailey, MD, PhD

    Resident Physician
    David Geffen School of Medicine
    Los Angeles, California, United States

    Disclosure information not submitted.

  • SZ

    Serena Zheng, MD

    Resident Physician
    UCLA School of Medicine
    Los Angeles, California, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • KK

    Kevork Kazanjian, MD

    Professor of Surgery
    UCLA School of Medicine
    Los Angeles, California, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Razmik Ghukasyan, MD, MBA: This individual has no financial relationships with ineligible companies.
Kevork Kazanjian, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Minimally invasive colectomies, when combined with enhanced recovery after surgery (ERAS) protocols, have been shown to reduce length of stay (LOS) and postoperative morbidity without increasing rates of anastomotic leak or locoregional recurrence. Intracorporeal anastomosis (ICA) has been associated with shorter LOS and improved recovery compared to extracorporeal anastomosis (ECA) in enterocolic anastomosis, but its impact on colorectal resections is less clear. This study aimed to compare outcomes between ICA and ECA in robot-assisted laparoscopic left-sided colectomies and proctectomies.

Methods/Interventions: A retrospective cohort study was conducted on patients who underwent minimally invasive left hemicolectomy, sigmoid colectomy, or proctectomy between 2020 and 2022 at a single academic center by a colorectal surgeon using either ICA or ECA. Primary endpoints were LOS and operative time (OT); secondary endpoints included anastomotic leaks, 30-day readmission, postoperative ileus, and hemorrhage. Univariate and multivariate quasiPoisson regression analyses were performed using incidence rate ratios (IRR).

Results/Outcomes: The study included 188 cases (53% sigmoid colectomy, 34% proctectomy, 12% left hemicolectomy), with 123 (65%) using ICA. Most cases (79%) were robotic, with colorectal adenocarcinoma (67%) and diverticular disease (29%) as primary indications. Laparoscopic resections were performed only when the robot was not available. The median OT was 282 min (IQR 232-374), and the median LOS = 2d (IQR 2-3). Demographic and other variables are listed in Table 1. Both univariate and multivariate analyses showed that ICA (Avg LOS = 2.2d) when compared with ECA (Avg LOS = 3.5d) is associated with shorter LOS (IRR=0.53 (95% CI 0.42,0.67); p< 0.001), while proctectomies (IRR=1.75 (95% CI 1.27,1.38); p< 0.001), and nutritional deficiency (serum albumin < 3.5) (IRR=2.52 (95% CI 1.57,3.88); p< 0.001) were associated with increased LOS. LOS associated with laparoscopic resections (Avg LOS = 3.0d), was not significantly different from robot assisted resections (Avg LOS = 2.5d; IRR=1.19 (95% CI 0.92,152); p=0.19) (Table 2A and 2B). Univariate analysis did not reveal any differences in OT for ICA when compared with ECA, (IRR=1.00 (95% CI 0.90,1.11); p< 0.001). Multivariate analysis only showed statistically significant increase in OT with proctectomies (IRR=1.27 (95% CI 1.09,1.48); p< 0.001) when compared with sigmoid colectomy (Table 3B). Given the overall low rate of 30-day postoperative complications, the study was not powered to generate meaningful regression analyses. Nevertheless, when comparing ICA to ECA there was no statistically significant difference in anastomotic leak (N = 3, F = 0.92; 95% CI (0.02,9.68); p = 1.00); postoperative ileus (N = 13, F = 1.12; 95% CI (0.10,4.65; p = 1.00); hemorrhage (N = 5, F = 2.53; 95% CI (0.20,22.9); p = 0.29), and 30-day readmission rates (N = 9, F = 1.06; 95% CI (0.10,5.88); p = 1.00).

Conclusion/Discussion: ICA significantly reduces LOS compared to ECA in left-sided colectomies and proctectomies without affecting OT. Robotic and laparoscopic ECA resulted in similar LOS. The study was underpowered to assess morbidity, mortality, and recurrence outcomes through regression analyses.