Ann Surg Treat Res.  2024 Jan;106(1):1-10. 10.4174/astr.2024.106.1.1.

Intracorporeal versus extracorporeal anastomosis in minimally invasive right hemicolectomy: systematic review and meta-analysis of randomized controlled trials

• Cheong C
• Kim NW
• Lee HS
• Kang J

• KMID: 2550245
• DOI: http://doi.org/10.4174/astr.2024.106.1.1

Abstract

Purpose
Compared with extracorporeal anastomosis (ECA), intracorporeal anastomosis (ICA) is expected to provide some benefits, including a shorter operation time and less intraoperative bleeding. Nevertheless, the benefits of ICA have mainly been evaluated in nonrandomized studies. Owing to the recent update of randomized controlled trials (RCTs) for minimally invasive surgery (MIS) of right hemicolectomy (RHC), the need to measure the actual effect by synthesizing the outcomes of these studies has emerged.
Methods
We performed a comprehensive search of the PubMed, Embase, and Cochrane databases (from inception to January 30, 2023) for studies that applied ICA and ECA for RHC with MIS. We included 7 RCTs. The operation time, intraoperative blood loss, conversion rate, length of incision, and postoperative outcomes such as ileus, anastomosis leakage, length of hospitalization, and postoperative pain were compared between ICA and ECA.
Results
A total of 740 patients were included in the study. Among them, 377 and 373 underwent ICA and ECA, respectively. There were significant differences in age (P = 0.003) and incision type (P < 0.001) between ICA and ECA. ICA was associated with a significantly longer operation time (P = 0.033). Although the postoperative pain associated with ICA was significantly lower than that associated with ECA on postoperative day 2 (POD 2) (P = 0.003), it was not different on POD 3 between the groups. Other perioperative outcomes were similar between the 2 groups.
Conclusion
In this meta-analysis, ICA did not significantly improve short-term outcomes compared to ECA; other advantages to overcome ICA’s longer operation time are not clear.

Keyword

Anastomosis; Ascending colon; Colectomy; Minimally invasive surgical procedures

Figure

• 

  Fig. 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flowchart describing the selection pipeline for studies included in our study. RCT, randomized controlled trial.

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  Fig. 2 Forest plot of intraoperative outcomes between intracorporeal and extracorporeal anastomosis. (A) Operation time (min). (B) Intraoperative blood loss (mL). (C) Conversion rate. (D) Length of incision (cm). SD, standard deviation; SMD, standardized mean difference; CI, confidence interval; OR, odds ratio.

• 

  Fig. 3 Forest plot of perioperative outcomes between intracorporeal and extracorporeal anastomosis. (A) Clavien-Dindo classification of ≥III. (B) Surgical site infection. (C) Pulmonary complication. (D) Postoperative bleeding. (E) Ileus. (F) Anastomosis leakage. (G) Reoperation. (H) Hospitalization (days). (I) Readmission. OR, odds ratio; SMD, standardized mean difference; CI, confidence interval; SD, standard deviation.

• 

  Fig. 4 Forest plot of postoperative pain (visual analogue scale) between intracorporeal and extracorporeal anastomosis. (A) Postoperative pain in postoperative day (POD) 1. (B) Postoperative pain in POD 2. (C) Postoperative pain in POD 3. SD, standard deviation; SMD, standardized mean difference; CI, confidence interval.

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