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Meta‑analysis of randomized controlled trials comparing intracorporeal versus extracorporeal anastomosis in minimally invasive right hemicolectomy: upgrading the level of evidence

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Abstract

Background

Minimally invasive right hemicolectomy has been increasingly used for the treatment of right hemicolectomy disease, and both intracorporeal anastomosis (ICA) and extracorporeal anastomosis (ECA) are available to restore intestinal continuity. However, the advantages and disadvantages of these two anastomoses are highly controversial. The present meta-analysis evaluated the effectiveness of ICA versus ECA in minimally invasive right colectomy to improve the grade of evidence.

Methods

We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) comparing intracorporeal versus extracorporeal anastomosis in laparoscopic or robotic right hemicolectomy published from database inception to February 2023. Two researchers performed the literature review, data extraction, bias assessment, and meta-analysis of the data using Review Manager 5.4 software.

Results

Seven RCTs with a total of 750 patients were included in the meta-analysis. The results showed a lower incidence of postoperative paralytic ileus (RR 0.62, 95% CI 0.39 ~ 0.99, p = 0.04) and shorter incision length (MD − 1.38; 95% CI: − 1.98 ~  − 0.78, p < 0.00001), but longer operative time (MD 10.69; 95% CI: 2.76 ~ 18.63, p = 0.008). The remaining events including bleeding (RR 0.49, 95% CI: 0.12 ~ 2.04, p = 0.33), anastomotic leak (RR 0.62, 95% CI: 0.39 ~ 0.99, p = 0.85), surgical site infection (RR 0.15, 95% CI: 0.22 ~ 1.25, p = 0.15), overall perioperative morbidity (RR 0.86, 95% CI: 0.58 ~ 1.26, p = 0.44), number of harvested lymph nodes (MD 0.75; 95% CI: − 0.15 ~ 1.65, p = 0.10), and length of hospital stay (MD − 0.27; 95% CI: − 0.91 ~ 0.38, p = 0.42) were not statistically significant.

Conclusions

Compared to ECA, ICA in minimally invasive right hemicolectomy reduced the risk of postoperative paralytic ileus and shortened the length of the incision but prolonged the operative time.

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Data availability

The raw data supporting the conclusions of this manuscript will be made available by the authors without undue reservation to any qualified researcher.

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Authors and Affiliations

  1. Department of General Surgery, Qingdao Municipal Hospital, Qingdao Clinical Medical College, Nan**g Medical University, Qingdao, 266071, Shandong, China

    Tuo Zhang & Weizheng Mao

  2. Department of General Surgery, Qingdao Municipal Hospital of Qingdao University, Qingdao, 266071, Shandong, China

    Yigong Sun

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Contributions

Weizheng Mao designed the study. Tuo Zhang screened the literature, extracted the data, and completed the graphing and writing. Yigong Sun screened the literature and extracted the data. All authors contributed to the writing and revisions of the paper and approved the final version.

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Correspondence to Weizheng Mao.

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Zhang, T., Sun, Y. & Mao, W. Meta‑analysis of randomized controlled trials comparing intracorporeal versus extracorporeal anastomosis in minimally invasive right hemicolectomy: upgrading the level of evidence. Int J Colorectal Dis 38, 147 (2023). https://doi.org/10.1007/s00384-023-04445-2

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