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

Zheng, Jian-Chun; Zhao, Shuai; Chen, Wei; Tang, Yu; Wang, Yingying; Wu, Jian-Xiang

doi:10.1007/s00423-021-02235-4

Cited by 18 publications

(25 citation statements)

References 43 publications

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“…However, there were no statistically significant differences between the two groups with regard to postoperative ileus (RR, 0.72; 95% CI, 0.3-1.77; p = 0.48) [15]. Zheng et al [18] in a systematic review reported that IA is associated with a significantly earlier bowel recovery (p < 0.01), and shorter hospitalization duration (p < 0.01) than EA. The postoperative ileus was similar between the IA and EA groups (p > 0.05).…”

Section: Postoperative Outcomesmentioning

confidence: 94%

“…The incision length was significantly shorter in the IA group than that in the EA group [ 12 , 15 , 18 ]. The extraction incision size is limited only by the size of the diseased segment in IA, but extension of the incision is necessary to enable the transverse colon to reach and complete the EA.…”

Section: Operative Outcomesmentioning

confidence: 99%

“…Regarding intraoperative blood loss, in a systematic review, volume of intraoperative blood loss was lower in IA group compared with EA group (MD, –7.76; 95% CI, –13.48 to –2.04; p < 0.01) [ 18 ]. The authors hypothesized that this phenomenon may be related to clear visualization of mesentery during the procedure, refinements of laparoscopic techniques and wide application of efficient laparoscopic instruments for effective hemostasis.…”

Section: Operative Outcomesmentioning

confidence: 99%

“…Zheng et al [ 18 ] in a systematic review reported that IA is associated with a significantly earlier bowel recovery ( p < 0.01), and shorter hospitalization duration ( p < 0.01) than EA. The postoperative ileus was similar between the IA and EA groups ( p > 0.05).…”

Section: Postoperative Outcomesmentioning

confidence: 99%

“…Potential reasons may be compromised vascular supply following mesenteric injuries caused by exteriorization of the bowel, traction, and hand-sewn anastomosis [ 14 , 22 , 23 ]. Two recent meta-analyses reported no significant differences in the rate of anastomotic leaks between the IA and EA (RR, 1.34; 95% CI, 0.58–3.13; p = 0.5 and odds ratio [OR], 0.81; 95% CI, 0.56–1.16; p = 0.25) [ 14 , 18 ]. This is probably because staplers were also used mostly in the EA group.…”

Section: Postoperative Outcomesmentioning

confidence: 99%

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Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery

Baek

2022

J Minim Invasive Surg

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Laparoscopic right colectomy is currently considered the standard treatment for right colon cancer. After excision of the right colon, minimally invasive options for ileocolonic anastomosis include extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA). However, the choice of anastomotic technique remains debated. As the entire IA is performed in the abdominal cavity, it is known for its advantages of a faster intestinal recovery and small incision. However, IA is time-consuming and technically difficult, limiting its widespread use. Recently, the robotic approach has increased the adoption of intracorporeal anastomotic techniques owing to the benefits of endowrist-articulated instruments and staplers. Except for a small incision and faster bowel recovery, the outcomes of the two anastomoses methods are inconsistent. To date, there has been no clear conclusion regarding whether IA or EA should be used to treat right colon cancer. This review aimed to investigate the current evidence relating to intraoperative outcomes and shortterm postoperative results between both anastomotic approaches.

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Section: Postoperative Outcomesmentioning

confidence: 94%

Section: Operative Outcomesmentioning

confidence: 99%

Section: Operative Outcomesmentioning

confidence: 99%

Section: Postoperative Outcomesmentioning

confidence: 99%

Section: Postoperative Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery

Baek

2022

J Minim Invasive Surg

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Gastrointestinal functions after laparoscopic right colectomy with intracorporeal anastomosis: a pilot randomized clinical trial on effects of abdominal drain, prolonged antibiotic prophylaxis, and D3 lymphadenectomy with complete mesocolic excision

Sica,

Siragusa,

Pirozzi

et al. 2024

Int J Colorectal Dis

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Purpose Routine use of abdominal drain or prolonged antibiotic prophylaxis is no longer part of current clinical practice in colorectal surgery. Nevertheless, in patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (ICA), it may reduce perioperative abdominal contamination. Furthermore, in cancer patients, prolonged surgery with extensive dissection such as central vascular ligation and complete mesocolon excision with D3 lymphadenectomy (altogether radical right colectomy RRC) is called responsible for affecting postoperative ileus. The aim was to evaluate postoperative resumption of gastrointestinal functions in patients undergoing right hemicolectomy for cancer with ICA and standard D2 dissection or RRC, with or without abdominal drain and prolonged antibiotic prophylaxis. Methods Monocentric factorial parallel arm randomized pilot trial including all consecutive patients undergoing laparoscopic right hemicolectomy and ICA for cancer, in 20 months. Patients were randomized on a 1:1:1 ratio to receive abdominal drain, prolonged antibiotic prophylaxis or neither (I level), and 1:1 to receive RRC or D2 colectomy (II level). Patients were not blinded. The primary aim was the resumption of gastrointestinal functions (time to first gas and stool, time to tolerated fluids and food). Secondary aims were length of stay and complications’ rate. ClinicalTrials.gov no. NCT04977882. Results Fifty-seven patients were screened; according to sample size, 36 were randomized, 12 for each arm for postoperative management, and 18 for each arm according to surgical techniques. A difference in time to solid diet favored the group without drain or antibiotic independently from standard or RRC. Furthermore, when patients were divided with respect to surgical technique and into matched cohorts, no differences were seen for primary and secondary outcomes. Conclusion Abdominal drainage and prolonged antibiotic prophylaxis in patients undergoing right hemicolectomy for cancer with ICA seem to negatively affect the resumption of a solid diet after laparoscopic right hemicolectomy with ICA for cancer. RRC does not seem to influence gastrointestinal function recovery.

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

Tariq

Mohiuddin

2022

Langenbecks Arch Surg

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We recently read the meta-analysis by Zheng et al. titled "Comparison of intracorporeal and extracorporeal anastomosis and resection in right colectomy: a systematic review and meta-analysis" published in the September issue of Langenbeck's Archives of Surgery [1]. The authors are commended for a well-written paper involving 30 studies with 4317 participants. However, we would like to communicate some of the methodological concerns regarding this paper.Firstly, the authors utilized the Newcastle-Ottawa scale for quality assessment of all the included studies in this meta-analysis. The Newcastle-Ottawa scale was developed to appraise the quality of observational studies; therefore, it is inappropriate to use it for randomized control trials (RCTs) [2]. We suggest the authors to separately assess the quality of randomized control trials using the Cochrane Collaboration's Risk of Bias (ROB) Tool [3]. Secondly, as described in the Cochrane Handbook for Systematic Reviews, RCTs and observational studies cannot be combined unless the results are related to the harmful/adverse effects of the intervention [4]. Therefore, it is a methodological error to combine RCTs with observational studies in this meta-analysis. A better approach is to make a subgroup analysis of RCTs and observational studies for all the outcomes. Thirdly, high heterogeneity was observed in results of several study outcomes (surgical duration I 2 = 83%, intraoperative blood loss I 2 = 81%, number of harvested lymph nodes I 2 = 71%, incision length I 2 = 95%, hospitalization duration I 2 = 87%, time to first fluid I 2 = 98%, and time to first defecation I 2 = 98%), thus affecting the reliability of conclusions reached. Sadly, the authors did not discuss the * Muhammad Ali Tariq

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

Cited by 18 publications

References 43 publications

Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery

Extracorporeal versus intracorporeal anastomosis for right colon cancer surgery

Gastrointestinal functions after laparoscopic right colectomy with intracorporeal anastomosis: a pilot randomized clinical trial on effects of abdominal drain, prolonged antibiotic prophylaxis, and D3 lymphadenectomy with complete mesocolic excision

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

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