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Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Colectomy: A Meta-Analysis and Systematic Review

  • Surgery and Surgical Innovations in Colorectal Cancer (M Al-Kasspooles, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of Review

Laparoscopic hemicolectomy (LHC) is widely used to treat benign and malignant colorectal disease. However, the optimal method to restore intestinal continuity is still controversial; hence, this study aims to compare the safety and efficacy of intracorporeal anastomosis (IA) with extracorporeal anastomosis (EA).

Recent Findings

Current literature comprises largely of retrospective cohort studies and three significant randomized controlled trials examining the differences between IA and EA in mostly right-sided colectomies. The evidence points to superior intraoperative and postoperative outcomes such as reduced incision length, incidence of wound infection and length of stay for IA, but with incongruous findings on outcomes such as anastomotic leakage and lymph node yield. Likewise, existing meta-analyses have reached differing conclusions about some of these key outcomes.

Summary

This paper provides a timely update to existing reviews and shows that IA is associated with superior intraoperative, postoperative and long-term recovery outcomes. We provide more conclusive evidence that lymph node yield for cancer patients is improved in IA. Furthermore, lymph node yield and lowered readmission rate appeared to be more pronounced in patients with higher BMI through regression analysis. Our key recommendation is for surgeons to acquire a high level of proficiency in performing IA to improve patient outcomes.

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  1. Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore

    Timothy Jia Rong Lam, Shamill Amedot Udonwa, Clyve Yu Leon Yaow & Kameswara Rishi Yeshayahu Nistala

  2. Division of Colorectal Surgery, University Surgical Cluster, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Choon Seng Chong

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Conception and Design: Choon Seng Chong.

Acquisition of data: Timothy Jia Rong Lam, Shamill Amedot Udonwa.

Interpretation of data: Clyve Yu Leon Yaow, Kameswara Rishi Yeshayahu Nistala.

Drafting of article: Timothy Jia Rong Lam, Shamill Amedot Udonwa.

Critical revision of article: Clyve Yu Leon Yaow, Kameswara Rishi Yeshayahu Nistala, Choon Seng Chong.

Approval of final manuscript: Timothy Jia Rong Lam, Shamill Amedot Udonwa, Clyve Yu Leon Yaow, Kameswara Rishi Yeshayahu Nistala, Choon Seng Chong.

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Correspondence to Choon Seng Chong.

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Timothy Jia Rong Lam, Shamill Amedot Udonwa, Clyve Yu Leon Yaow, Kameswara Rishi Yeshayahu Nistala, and Choon Seng Chong have nothing to disclose.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

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Lam, T.J.R., Udonwa, S.A., Yaow, C.Y.L. et al. Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Colectomy: A Meta-Analysis and Systematic Review. Curr Colorectal Cancer Rep 18, 1–17 (2022). https://doi.org/10.1007/s11888-022-00473-2

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