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

AbstractPurpose of ReviewLaparoscopic 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 FindingsCurrent 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.SummaryThis 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.
Source: Current Colorectal Cancer Reports - Category: Cancer & Oncology Source Type: research