A multicenter trial evaluating the short-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic colectomy for overweight and obese patients with colon cancer: a secondary analysis of the ICAN study.

[PURPOSE] The safety and benefits of intracorporeal anastomosis (ICAN) in overweight and obese colon cancer patients remain unclear. This study aimed to evaluate the short-term outcomes of ICAN compared to extracorporeal anastomosis (ECAN) in this population.

[METHODS] This nationwide multicenter retrospective cohort study included 46 institutions. Body mass index (BMI) ≥ 25 kg/m in patients with clinical stage 0-III colon adenocarcinoma who underwent laparoscopic colectomy were assessed using propensity score matching to compare ICAN and ECAN.

[RESULTS] Between January 2020 and December 2021, 361 patients were analyzed (ICAN, n = 191; ECAN, n = 170). ICAN was associated with a longer operative time (252 vs. 232 min, p < 0.001), but significantly less blood loss (5 vs. 15.5 ml, p < 0.001) and a shorter wound length (4 vs. 5 cm, p < 0.001). There were no significant differences in the intraoperative (1.6 vs. 1.8%) or postoperative complication rates (9.4 vs. 7.6%). The time to first stool passage was shorter in the ICAN group (3 (IQR 2-4) vs. 3 (IQR 3-5) days, p < 0.001).

[CONCLUSIONS] ICAN is safe and beneficial for overweight and obese patients undergoing laparoscopic colectomy, offering reduced blood loss, smaller incisions, and a faster bowel recovery.

[TRIAL REGISTRATION] This study was registered in the UMIN Clinical Trials Registry System in 2022 (UMIN000047994).