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Comparison of intracorporeal and extracorporeal anastomosis and resection in right colectomy: a systematic review and meta-analysis

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Laparoscopic surgery is the standard surgical approach for colon cancer. However, there is no standard surgery for right colectomy. Selection between total laparoscopic right colectomy (TLRC) and laparoscopic-assisted right colectomy (LARC) is a topic of interest. In this systematic review, we compared the short-term outcomes of TLRC and LARC in the treatment of right colon cancer.

Methods

We identified studies (PubMed, Web of Science, Cochrane Library, Embase) comparing TLRC and LARC up to February 2021. Surgical duration; volume of intraoperative blood loss; number of harvested lymph nodes; incision length; hospitalization duration; time to first flatus; time to first defecation; and anastomotic leakage, ileus, and wound infection were compared.

Results

Thirty studies (TLRC, 1948 patients; LARC, 2369 patients) were evaluated. All studies were retrospective, except seven prospective studies, three RCTs, and three case–control studies. TLRC demonstrated lesser intraoperative blood loss volume (P < 0.01), less frequent intraoperative conversion to laparotomy (P = 0.02), shorter hospitalization duration (P < 0.01), smaller incision length (P < 0.01), shorter time to first flatus (P < 0.01) and first defecation (P < 0.01), and lesser frequent wound infection (P < 0.01) compared with LARC. The surgical duration, number of harvested lymph nodes, anastomotic leakage, and ileus were similar between TLRC and LARC (P > 0.05).

Conclusion

TLRC is associated with significantly earlier bowel recovery, lesser blood loss, smaller incision length, lower rate of conversion, shorter hospitalization duration, and lesser frequent wound infection compared with LARC.

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References

  1. Benson AB, Venook AP, Al-Hawary MM, Cederquist L, Chen YJ, Ciombor KK, Cohen SA, Cooper HS, Deming D, Engstrom PF et al (2018) NCCN Guidelines Insights: colon cancer, Version 2.2018. J Natl Compr Cancer Netw 16:359–369

    Article  Google Scholar 

  2. Pellino G, Warren O, Mills S, Rasheed S, Tekkis PP, Kontovounisios C (2018) Comparison of Western and Asian guidelines concerning the management of colon cancer. Dis Colon Rectum 61:250–259

    Article  PubMed  Google Scholar 

  3. Pilleron S, Sarfati D, Janssen-Heijnen M et al (2019) Global cancer incidence in older adults, 2012 and 2035: a population-based study. Int J Cancer 144:49–58

    Article  CAS  PubMed  Google Scholar 

  4. Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424

    Article  PubMed  Google Scholar 

  5. Wu C, Gu K, Gong Y et al (2020) Analysis of incidence and mortality of colorectal cancer in China, 2015. Zhongguo Ai Zheng Za Zhi (in Chinese) 30:241–245

    Google Scholar 

  6. Guillou PJ, Darzi A, Monson JR (1993) Experience with laparoscopic colorectal surgery for malignant disease [J]. surgical oncology 2(Suppl 1):43–9

    Article  PubMed  Google Scholar 

  7. Milone M, Elmore U, Vignali A, Gennarelli N, Manigrasso M, Burati M et al (2018) Recovery after intracorporeal anastomosis in laparoscopic right hemicolectomy: a systematic review and meta-analysis [J]. Langenbecks Archive of Surgery 403(1):1–10

    Article  Google Scholar 

  8. Shatari T, Fujita M, Nozawa K, Haku K, Niimi M, Ikeda Y et al (2003) Vascular anatomy for right colon lymphadenectomy [J]. Surg Radiol Anat 25(2):86–88

    Article  CAS  PubMed  Google Scholar 

  9. Grams J, Tong W, Greenstein AJ, Salky B et al (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy [J]. Surg Endosc 24(8):1886–1891

    Article  PubMed  Google Scholar 

  10. Sun X, Qiu H, Fei K, Xu L, Lu J, Zhang J et al (2017) Comparison of intra-abdominal infection between intracorporeal anastomosis and extracorporeal anastomosis in patients undergoing laparoscopic right hemicolectomy. Zhonghua Wei Chang Wai Ke Za Zhi 20(8):891–895

    PubMed  Google Scholar 

  11. Feroci F, Lenzi E, Garzi A, Vannucchi A, Cantafio S, Scatizzi M et al (2013) Intracorporeal versus extracorporeal anastomosis after laparoscopic right hemicolectomy for cancer: a systematic review and meta-analysis. Int J Colorectal Dis 28(9):1177–1186

    Article  PubMed  Google Scholar 

  12. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13

    Article  PubMed  PubMed Central  Google Scholar 

  13. Allaix ME, Degiuli M, Bonino MA et al (2019) Intracorporeal or Extracorporeal Ileocolic Anastomosis After Laparoscopic Right Colectomy: A Double-blinded Randomized Controlled Trial. Ann Surg 270(5):762–767

    Article  PubMed  Google Scholar 

  14. Anania G, Santini M, Scagliarini L et al (2012) A totally mini-invasive approach for colorectal laparoscopic surgery. World J Gastroenterol 18(29):3869–3874

    Article  PubMed  PubMed Central  Google Scholar 

  15. Biondi A, Santocchi P, Pennestrì F et al (2017) (2017) Totally laparoscopic right colectomy versus laparoscopically assisted right colectomy: a propensity score analysis. Surg Endosc 31:5275–5282

    Article  PubMed  Google Scholar 

  16. Bollo J, Turrado V, Rabal A et al (2020) 2019) Randomized clinical trial of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy (IEA trial. Br J Surg 107(4):364–372

    Article  CAS  PubMed  Google Scholar 

  17. Bou Saleh N, Voron T (2020) De’Angelis N (2020) Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: results from the CLIMHET study group. Tech Coloproctol 24:585–592

    Article  CAS  PubMed  Google Scholar 

  18. Chaves JA, Idoate CP, Fons JB et al (2011) A case-control study of extracorporeal versus intracorporeal anastomosis in patients subjected to right laparoscopic hemicolectomy[J]. Cir Esp 89(1):24–30

    PubMed  Google Scholar 

  19. Erguner I, Aytac E, Baca B et al (2013) Total laparoscopic approach for the treatment of right colon cancer: a technical critique. Asian J Surg 36(2):58–63

    Article  PubMed  Google Scholar 

  20. Fabozzi M, Allieta R, Contul RB et al (2010) Comparison of short and medium-term results between laparoscopically assisted and totally laparoscopic right hemicolectomy: a case–control study. Surg Endosc Interv Tech 24:2085–2091

    Article  Google Scholar 

  21. Hanna MH, Hwang GS, Phelan MJ et al (2016) Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis. Surg Endosc 30(9):3933–3942

    Article  PubMed  Google Scholar 

  22. Hellan M, Anderson C, Pigazzi A (2009) Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS 13(3):312–317

    PubMed  PubMed Central  Google Scholar 

  23. Ishizaki T, Katsumata K et al. (2020) Comparison of intra-abdominal infection risk between intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy for colon cancer: a single-center retrospective study.

  24. Kwiatkowski AP, Stępińska G et al (2019) Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy – single center experience. Wideochir Inne Tech Maloinwazyjne 14(3):381–386

    PubMed  PubMed Central  Google Scholar 

  25. Lee KH, Ho J, Akmal Y et al (2013) Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer. Surg Endosc 27(6):1986–1990

    Article  PubMed  Google Scholar 

  26. Liao CK, Chern YJ et al. (2021) Short- and medium-term outcomes of intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: a propensity score-matched study.

  27. Magistro C, Di Lernia S, Ferrari G et al (2013) Totally laparoscopic versus laparoscopic-assisted right colectomy for colon cancer: is there any advantage in short-term outcomes? A prospective comparative assessment in our center. Surg Endosc 27(7):2613–2618

    Article  PubMed  Google Scholar 

  28. Marchesi F, Pinna F, Percalli L et al (2013) Totally laparoscopic right colectomy: theoretical and practical advantages over the laparo-assisted approach. J Laparoendosc Adv Surg Tech 23(5):418–424

    Article  Google Scholar 

  29. Mari GM, Crippa J, Costanzi ATM et al (2018) Intracorporeal anastomosis reduces surgical stress response in laparoscopic right hemicolectomy: a prospective randomized trial. Surg Laparosc Endosc Percutan Tech 28(2):77–81

    Article  PubMed  Google Scholar 

  30. Martinek L, You K, Giuratrabocchetta S, Gachabayov M, Lee K, Bergamaschi R (2018) Does laparoscopic intracorporeal ileocolic anastomosis decreases surgical site infection rate? A propensity score-matched cohort study. Int J Colorectal Dis 33(3):291–298

    Article  CAS  PubMed  Google Scholar 

  31. Milone M, Elmore U, Di Salvo E et al (2015) Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc 29(8):2314–2320

    Article  PubMed  Google Scholar 

  32. Roscio F, Bertoglio C, De Luca A et al (2012) Totally laparoscopic versus laparoscopic assisted right colectomy for cancer. Int J Surg 10(6):290–295

    Article  PubMed  Google Scholar 

  33. Scatizzi M, Kröning KC, Borrelli A et al (2010) (2010) Extracorporeal versus intracorporeal anastomosis after laparoscopic right colectomy for cancer: a case–control study [J]. World J Surg 34(12):2902–2908

    Article  PubMed  Google Scholar 

  34. Shapiro R, Keler U, Segev L et al (2016) Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis. Surg Endosc 30(9):3823–3829

    Article  PubMed  Google Scholar 

  35. Su H, Jin WS et al (2019) (2019) Intra-corporeal delta-shaped anastomosis in laparoscopic right hemicolectomy for right colon cancer: a safe and effective technique. Gastroenterology Report 7(4):272–278

    Article  PubMed  PubMed Central  Google Scholar 

  36. Trastulli S, Coratti A, Guarino S et al (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29(6):1512–1521

    Article  PubMed  Google Scholar 

  37. Trépanier M, Valin-Thorburn A et al (2020) (2020) Intracorporeal versus extracorporeal anastomosis for right colectomy does not affect gastrointestinal recovery within an enhanced recovery after surgery program. Surg Endosc 34:4601–4608

    Article  PubMed  Google Scholar 

  38. Jian-Cheng TU, Shu-Sheng W, Bo Z, Jian F, Liang Z (2016) Total laparoscopic right hemicolectomy with 3-step stapled intracorporeal isoperistaltic ileocolic anastomosis for colon cancer: an evaluation of short-term outcomes. Medicine (Baltimore) 95(48):e5538

    Article  Google Scholar 

  39. Vergis AS, Steigerwald SN, Bhojani FD et al (2015) Laparoscopic right hemicolectomy with intracorporeal versus extracorporeal anastomosis: a comparison of short-term outcomes. Can J Surg 58:63–68

    Article  PubMed  PubMed Central  Google Scholar 

  40. Vignali A, Bissolati M, Nardi PD, Palo SD, Staudacher C (2016) Extracorporeal vs intracorporeal ileocolic stapled anastomoses in laparoscopic right colectomy an interim analysis of a randomized clinical trial. J Laparoendosc Adv Surg Tech A 26(5):343–8

    Article  PubMed  Google Scholar 

  41. Vignali A, Elmore U, Lemma M, Guarnieri G, Radaelli G, Rosati R (2018) Intracorporeal versus extracorporeal anastomoses following laparoscopic right colectomy in obese patients: a case-matched study. Dig Surg 35(3):236–242

    Article  PubMed  Google Scholar 

  42. Zhang MG, Lu Z, Zheng ZX, Cheng P, Zhou HT, Wang XS (2021) Comparison of short-term outcomes between totally laparoscopic right colectomy and laparoscopic-assisted right colectomy: a retrospective study in a single institution on 300 consecutive patients. Surg Endosc. 2021 Jan 11

  43. Song YA (2018) Effect of laparoscopic and open radical resection of colorectal cancer on gastrointestinal function in patients. China Modern Doctor 56(25):48-50+4

    Google Scholar 

  44. Lin W, Gong J, Fang DL (2017) Bao Z (2017) The study of enhance recovery after surgery in the application of the completely laparoscopic right hemicolectomy. Journal of Digestive Oncology 9(03):173–177

    Google Scholar 

  45. Yamamoto S, Fujita S, Akasu T, Ishiguro S, Kobayashi S (2007) Moriya Y (2007) Wound infection after elective laparoscopic surgery for colorectal carcinoma. Surg Endosc 21(12):2248–2252

    Article  PubMed  Google Scholar 

  46. Ma Y, Yang XY (2014) Related risk factors for postoperative incision infections in patients with colorectal cancer. Chinese Journal of Nosocomiology. 2014, 24 (17)

  47. Kercher KW, Nguyen TH, Harold KL, Poplin ME, Matthews BD, Sing RF, Heniford BT (2004) Plastic wound protectors do not affect wound infection rates following laparoscopic-assisted colectomy.2004,18(1):148-51

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Authors and Affiliations

  1. Department of Emergency, The Second Hospital of Jiaxing, Jiaxing, 314000, Zhejiang Province, China

    Jian-Chun Zheng, Wei Chen, Yu Tang, Ying-Ying Wang & Jian-Xiang Wu

  2. Department of Surgical Oncology, Liaoning Health Industry Group Fuxin Mine General Hospital, Fuxin, 123000, Liaoning Province, China

    Shuai Zhao

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  1. Jian-Chun Zheng
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Zheng, JC., Zhao, S., Chen, W. et al. Comparison of intracorporeal and extracorporeal anastomosis and resection in right colectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 406, 1789–1801 (2021). https://doi.org/10.1007/s00423-021-02235-4

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