Abstract
Aim: This systemic review aims to determine if intracorporeal anastomosis (IA) adds value to patient outcomes without compromising operative and oncological safety when compared to extracorporeal anastomosis (EA) in laparoscopic colectomies. This is the first systematic review with meta-analysis to evaluate the outcomes in a combined fashion including both laparoscopic right and left colectomies. Methods: A systematic review of Medline, EMBASE, Cochrane Library, and PubMed was performed on studies analysing direct comparison between IA and EA. The primary outcome was anastomotic leakage. Quality assessment was carried out using a modified Institute of Health Economics appraisal tool. Meta-analysis was performed using a random-effects model. Results: A total of 24 papers with 2,674 patients were included in the analysis. No significant difference was found in anastomotic leakage (OR = 0.84; 95%CI: 0.54-1.31; P = 0.44) and short-term mortality (OR = 0.56; 95%CI: 0.20-1.58; P = 0.27) between the IA and EA cohorts. The IA cohort was associated with faster return of bowel function [MD = -0.53 days; 95%CI: -0.67-(-0.39); P < 0.00001] and lower incidence of surgical site infection (OR = 0.52; 95%CI: 0.31-0.85; P = 0.009). The number of lymph nodes harvested was higher in IA (MD = 1.05; 95%CI: 0.19-1.91; P = 0.02; I2 = 83%) with considerable heterogeneity. Conclusion: Intracorporeal anastomosis can be considered a safe alternative technique in laparoscopic colectomies, with potential benefits in patient outcomes. A lack of randomised studies and heterogeneity need to be addressed by additional high-quality trials.
Highlights
Laparoscopic colectomy has been increasingly performed worldwide since its introduction and it is currently considered the “gold standard” surgical care for benign and malignant colon resections[1]
The number of lymph nodes harvested was higher in intracorporeal anastomosis (IA) (MD = 1.05; 95%confidence interval (CI): 0.19-1.91; P = 0.02; I 2 = 83%) with considerable heterogeneity
Extracorporeal anastomosis is the preferred technique as intracorporeal anastomosis (IA) is considered more technically challenging due to the need for laparoscopic suturing and the potential risk of intra-abdominal spillage[3,4]
Summary
Laparoscopic colectomy has been increasingly performed worldwide since its introduction and it is currently considered the “gold standard” surgical care for benign and malignant colon resections[1]. The most common indication for the colon resection is malignancy, which is the second leading cause of cancer death worldwide, with a lifetime incidence of approximately 6%[2]. The term “laparoscopic colectomy” refers to laparoscopic-assisted colectomy with extracorporeal anastomosis (EA). Extracorporeal anastomosis is the preferred technique as intracorporeal anastomosis (IA) is considered more technically challenging due to the need for laparoscopic suturing and the potential risk of intra-abdominal spillage[3,4]. IA is less invasive, and there is accumulating data to support its safety and potential short-term benefits in the post-operative period[6,7]. Available meta-analyses are limited to right colectomies based on limited observational studies while there is a paucity of data on left colectomies
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