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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Comparison of different anastomosis methods in laparoscopically assisted left hemicolectomy for colon cancer
Fan Li, Yi-Lin Xie, Dong Xu, Chuan-Hui Lu, Jun-Wei Wu, Jin-Xue Ma, Guo-Xian Guan, Hai-Xing Wang
Fan Li, Chuan-Hui Lu, Guo-Xian Guan, Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University, 361001 Xiamen, Fujian Province, China
Fan Li, Chuan-Hui Lu, The School of Clinical Medicine, Fujian Medical University, Xiamen 361000, Fujian Province, China
Yi-Lin Xie, Hai-Xing Wang, Department of Endoscopy Center, The First Affiliated Hospital of Xiamen University, Xiamen 361000, Fujian Province, China
Dong Xu, Department of Gastroenterology, The First Affiliated Hospital of Xiamen University, Xiamen 360001, Fujian Province, China
Jun-Wei Wu, Department of Colorectal Surgery, The Graduate School of Fujian Medical University, Xiamen 360001, Fujian Province, China
Jin-Xue Ma, Department of General Surgery, Wuzhong People's Hospital of Ningxia Medical University, Ningxia 751199, Gansu Province, China
Co-first authors: Fan Li and Yi-Lin Xie.
Author contributions: Wang HX contributed to conceptualization; Li F contributed to curation, formal analysis, writing–original draft, review and editing; Xie YL, Xu D, Wu JW, Ma JX, Lu CH contributed to investigation; Guan GX contributed to methodology, project administration, resources.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and was approved by the ethics board of the First Affiliated Hospital of Xiamen University and the First Affiliated Hospital of Fujian Medical University [No. 2024 Scientific Research Ethics Examination Number (014)].
Informed consent statement: Informed consent was obtained from all individual participants included in the study. For participants unable to provide consent (e.g., due to incapacity), written informed consent was obtained from their legally authorized representatives. The need for informed consent was waived by the Institutional Review Board for retrospective analyses involving de-identified data, in accordance with ethical regulations.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this work, including but not limited to financial ties, personal relationships, or professional affiliations that could bias the study design, data interpretation, or manuscript preparation.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request, subject to ethical restrictions regarding patient privacy. De-identified data will be shared to the extent permitted by the Institutional Review Board.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hai-Xing Wang, Director, Professor, Department of Endoscopy Center, The First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Xiamen 361000, Fujian Province, China.
wanghaixing0908@126.com
Received: June 26, 2025
Revised: August 21, 2025
Accepted: October 22, 2025
Published online: November 16, 2025
Processing time: 143 Days and 22.8 Hours
BACKGROUND
Left colon cancer surgery relies on laparoscopic hemicolectomy, with digestive tract reconstruction critical. End-to-side anastomosis (ESA) and side-to-side anastomosis (SSA) anastomoses are common, but their comparative outcomes, especially in splenic flexure handling and efficacy, need clarification. This study compares ESA and SSA to guide surgical practice.
AIM
To compare the clinical outcomes of laparoscopically assisted left hemicolectomy with ESA and SSA.
METHODS
A total of 334 patients were included, with 105 patients from the First Affiliated Hospital of Xiamen University and 229 patients from the First Affiliated Hospital of Fujian Medical University, between January 1, 2012, and May 31, 2020. The patients were divided into two groups: 146 cases in the ESA group and 188 cases in the SSA group. Clinical data from both groups were compared, and the survival prognosis was followed up.
RESULTS
The operation time for the ESA group was significantly shorter than that of the SSA group (197.1 ± 57.7 minutes vs 218.6 ± 67.5 minutes, χ2 = 4.298, P = 0.039). There were no significant differences between the two groups in intraoperative blood loss, postoperative pain score at 48 hours, time to first bowel movement, number of lymph nodes dissected, or postoperative complications such as anastomotic leakage, bleeding, stenosis. and adhesive intestinal obstruction at 6 months, 12 months, and 24 months (P > 0.05). Specifically, the incidence of complications like anastomotic leakage was 2.1% in the ESA group vs 4.3% in the SSA group (P = 0.264). The 5-year disease-free survival (DFS) rate was 66.4% for the ESA group and 63.9% for the SSA group (P = 0.693). There were no significant differences in the overall survival rate between the two groups. The incidence of splenic laceration was significantly higher in the SSA group (3.7% vs 0.7%, P = 0.018). Overall, the 5-year DFS was 66.4% for ESA and 63.9% for SSA, with no significant difference in survival between the groups (P = 0.693).
CONCLUSION
Both laparoscopically assisted left hemicolectomy with ESA and SSA are feasible and offer comparable long-term outcomes. ESA may reduce the need for splenic flexure dissociation, particularly when the tumor is located at the descending colon or its junction with the sigmoid colon, and especially in obese patients, elderly individuals with multiple complications, or those with severe adhesions in the splenic flexure of the surgical field.
Core Tip: Both laparoscopically assisted left hemicolectomy with end-to-side anastomosis (ESA) and side-to-side anastomosis are feasible and offer comparable long-term outcomes. ESA may reduce the need for splenic flexure dissociation, particularly when the tumor is located at the descending colon or its junction with the sigmoid colon.
