EP403 - Comparative Analysis Of Clinical Outcomes Between Total Intracorporeal Versus Extracorporeal Anastomosis In Robotic Left-sided And Rectal Colectomies: A Single-Center Experience

Purpose/Background: Robotic intracorporeal anastomosis has been more commonly studied in right-sided anastomosis, whereas the data on left-sided anastomosis is scarce. We present the largest cohort of comparison in clinical outcomes between left-sided robotic total intracorporeal anastomosis (TICA) and robotic extracorporeal (ECA) anastomosis.

Methods/Interventions: A single-institution retrospective review was conducted for patients > 18 years old who underwent robotic left colectomy, sigmoidectomy, or low anterior resection from September 2022 to February 2025. Patients were stratified into those who had TICA or ECA. Outcome measures include length of stay (LOS), 30-day morbidity, blood loss, creation of stoma, morphine milligram equivalent (MME) use.

Results/Outcomes: Overall, 390 patients met the inclusion criteria. Of these, 297 patients underwent ECA and 93 patients underwent TICA by 6 different colorectal surgeons. After propensity score matching, 88 patients were matched for each group. Demographically, there was no difference in age, sex, race, body mass index, Charlson Comorbidity Index score, or Area Deprivation Index between the groups. Intraoperatively, TICA patients were found to have a lower estimated blood loss compared to ECA patients (30 ml versus 50 ml, p < 0.0001). Patients with an ECA were more likely to have an ostomy creation (19.5% versus 9.1%, p = 0.05). TICA patients were more likely to have a Pfannenstiel extraction site (81.6%) compared to a midline retrieval site in ECA patients (85.2%, p < 0.0001). There was no difference in the surgical indication, operative time, presence of intra-abdominal infection, or feculent contamination. Postoperatively, patients with TICA have a shorter median LOS compared to those with ECA (75.5 hours versus 93.5 hours, p = 0.02). Holding demographics variables constant, patients with TICA had 19.2% shorter length of stay than ECA patients. Additionally, patients with TICA used lower amounts of MME for pain control compared to those with ECA (98.8 mg/day versus 167.5 mg/day, p = 0.02). Holding demographics variables constant, patients with TICA used 31.5% less MME compared to ECA patients. We found no differences between the groups regarding ICU admission, surgical site infection, anastomotic leak, ileus diagnosis, reintubation, or 30-day readmission.

Conclusion/Discussion: Robotic left sided TICA compared to ECA is associated with shorter LOS, decreased use of narcotic pain medications, and lower rates of ostomy creation, further supporting the benefits of TICA in left sided colectomies and proctectomies without significant difference in 30 day post operative outcomes. Randomized control trials are needed to better delineate outcomes between the procedures.

Table 1
Demographic, intraoperative and post operative characteristics of ECA and TICA patients; BMI: body mass index, IBD: Inflammatory bowel disease, EBL: estimated blood loss, ICU: intensive care unit, SSI: surgical site infection, MME: morphine milligram equivalents