AB214. SOH26AB_0407. Intracorporeal vs. extracorporeal anastomosis in oncologic resections: trends and outcomes

Background: Delayed gastrointestinal (GI) recovery remains a major contributor to morbidity and prolonged hospitalisation following oncologic colectomies. Intracorporeal anastomosis (ICA) has been proposed to improve bowel function compared with extracorporeal anastomosis (ECA); however, the impact of anastomotic technique and configuration on clinical outcomes remains incompletely defined. We aimed to address this deficit in the literature.

Methods: A retrospective analysis of 77 oncologic colectomies performed between 2022 and 2025. Outcomes assessed included postoperative ileus (POI), prolonged POI, other complications, and length of stay (LOS). A subgroup evaluation was conducted in right hemicolectomies (n=40) comparing ICA vs. ECA as well as isoperistaltic vs. antiperistaltic orientation. Fisher’s exact and Wilcoxon rank-sum tests were applied.

Results: POI occurred in 49.4% (38/77), while prolonged POI occurred in 7.8% (6/77). Overall complications occurred in 23.4%, and prolonged POI was significantly associated with increased LOS (P=0.003). Within the right hemicolectomy subgroup, ICA demonstrated earlier tolerance to oral intake compared with ECA (POD 2 vs. 3.5, P=0.008). No significant differences between ICA and ECA in POI or complication rates. Isoperistaltic vs. antiperistaltic anastomosis did not significantly affect measured outcomes. Worse cancer stage showed higher complication rates and longer LOS.

Conclusions: ICA significantly accelerates postoperative GI recovery following right hemicolectomies, consistent with international evidence. Anastomotic configuration did not influence outcomes. These findings support broader adoption of ICA to enhance recovery and reduce LOS.

Keywords: Postoperative ileus (POI); intracorporeal anastomosis (ICA); extracorporeal anastomosis (ECA); colorectal cancer; ERAS