Comparison of Intracorporeal Isoperistaltic and Antiperistaltic Anastomoses in Robotic‐assisted Surgery for Right‐sided Colon Cancer

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Abstract
Background/Aim: To date, several clinical trials have compared isoperistaltic and antiperistaltic anastomosis; however, in the context of robot-assisted surgery (RAS), a consensus on the optimal approach has yet to be established. This study aimed to compare the short-term outcomes of intracorporeal isoperistaltic and antiperistaltic side-to-side anastomoses in RAS for right-sided colon cancer. Patients and Methods: A retrospective subgroup analysis was conducted using a database collected from a Japanese multicenter prospective study. Patients diagnosed with curatively resectable right-sided colon cancer (cStage I-IIIC) who underwent RAS with intracorporeal anastomosis were included. Surgical and postoperative outcomes were compared between the isoperistaltic and antiperistaltic anastomosis groups. Results: Among the 78 patients analyzed, 23 (29.5%) underwent antiperistaltic anastomosis and 55 (70.5%) underwent isoperistaltic anastomosis. There were no significant differences in age, sex, American Society of Anesthesiologists Physical Status score, previous abdominal surgical history, or clinical stage between the groups. Isoperistaltic anastomosis was more frequently performed in ascending and transverse colon cancers, whereas antiperistaltic anastomosis was more frequent in cecal cancers. Right hemicolectomy was significantly more frequent in the isoperistaltic group than in the antiperistaltic group (92.7% vs. 60.9%) (p=0.0014). The total operative time was longer in the antiperistaltic group, but the console and anastomosis times were comparable. No intraoperative complications, conversions, or transfusions were reported. Postoperative complication rates were similar between the two groups. Conclusion: This study demonstrated equivalent short-term outcomes between intracorporeal isoperistaltic and antiperistaltic anastomoses in RAS for right-sided colon cancer. Both techniques appear to be safe and effective, supporting the recommendation that surgeons maintain proficiency in both methods to allow flexibility based on intraoperative conditions.

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