Comparison of Intracorporeal and Extracorporeal Anastomosis and Resection in Right Colectomy: a Systematic Review and Meta-analysis

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.