Top

Techniques in Coloproctology

Published in:

10-08-2023 | Colectomy | Review

Intracorporeal or extracorporeal anastomosis after minimally invasive right colectomy: a systematic review and meta-analysis

Authors: A. I. Squillaro, J. Kohn, L. Weaver, A. Yankovsky, G. Milky, N. Patel, U. S. Kreaden, W. B. Gaertner

Published in: Techniques in Coloproctology | Issue 11/2023

Abstract

Purpose

As part of the wide adoption of minimally invasive surgery, intracorporeal anastomosis is becoming increasingly common. The benefits of minimally invasive versus open right colectomy are well known although the additional benefits of an intracorporeal anastomosis, performed laparoscopically or robotically, are unclear. The aim of this study was to assess the current literature comparing intracorporeal and extracorporeal anastomosis in the setting of laparoscopic and robotic-assisted right colectomy.

Methods

A systematic review and meta-analysis was conducted according to PRISMA and AMSTAR methods. Studies included were randomized controlled trials and prospective or retrospective cohort studies, between January 1 2010 and July 1 2021, comparing intracorporeal and extracorporeal anastomosis with laparoscopic and robotic approaches. Four groups were identified: laparoscopic extracorporeal anastomosis (L-ECA), laparoscopic intracorporeal anastomosis (L-ICA), robotic extracorporeal anastomosis (R-ECA), and robotic intracorporeal anastomosis (R-ICA). Operative time, rate of conversion to an open procedure, surgical site infection, reoperation within 30 days, postoperative complications within 30 days, and length of hospital stay were assessed.

Results

Twenty-one retrospective cohort studies were included in the final analysis. R-ICA and R-ECA had comparable operative times, but a robotic approach required more time than laparoscopic (68 min longer, p < 0.00001). Conversion to open surgery was 55% less likely in the R-ICA group vs. L-ICA, and up to 94% less likely in the R-ICA group in comparison to the R-ECA group. Length of hospital stay was shorter for R-ICA by a half day vs. R-ECA, and up to 1 day less vs. L-ECA. There were no differences in postoperative complications, reoperations, or surgical site infections, regardless of approach. However, the included studies all had high risks of bias due to confounding variables and patient selection.

Conclusion

Robotic-assisted right colectomy with intracorporeal anastomosis was associated with shorter length of hospitalization and decreased rate of conversion to open surgery, compared to either laparoscopic or extracorporeal robotic approaches. Prospective studies are needed to better understand the true impact of robotic approach and intracorporeal anastomosis in right colectomy.

Available only for authorised users

Papageorge CM, Zhao Q, Foley EF et al (2016) Short-term outcomes of minimally invasive versus open colectomy for colon cancer. J Surg Res 204:83–93. https://doi.org/10.1016/j.jss.2016.04.020CrossRefPubMedPubMedCentral

Juo Y-Y, Hyder O, Haider AH et al (2014) Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg 149:177–184. https://doi.org/10.1001/jamasurg.2013.3660CrossRefPubMedPubMedCentral

Hajirawala LN, Krishnan V, Leonardi C et al (2022) Minimally invasive surgery is associated with improved outcomes following urgent inpatient colectomy. JSLS 26:e2021.00075. https://doi.org/10.4293/jsls.2021.00075CrossRefPubMedPubMedCentral

Yamauchi S, Matsuyama T, Tokunaga M, Kinugasa Y (2021) Minimally invasive surgery for colorectal cancer. JMA J 4:17–23. https://doi.org/10.31662/jmaj.2020-0089CrossRefPubMedPubMedCentral

Segev L, Schtrechman G, Kalady MF et al (2022) Long-term outcomes of minimally invasive versus open abdominoperineal resection for rectal cancer: a single specialized center experience. Dis Colon Rectum 65:361–372. https://doi.org/10.1097/dcr.0000000000002067CrossRefPubMed

Fujii S, Tsukamoto M, Fukushima Y et al (2016) Systematic review of laparoscopic vs open surgery for colorectal cancer in elderly patients. World J Gastrointest Oncol 8:573. https://doi.org/10.4251/wjgo.v8.i7.573CrossRefPubMedPubMedCentral

Vogel JD, Felder SI, Bhama AR et al (2022) The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colon cancer. Dis Colon Rectum 65:148–177. https://doi.org/10.1097/dcr.0000000000002323CrossRefPubMed

Hall J, Hardiman K, Lee S et al (2020) The American Society of Colon and Rectal Surgeons clinical practice guidelines for the treatment of left-sided colonic diverticulitis. Dis Colon Rectum 63:728–747. https://doi.org/10.1097/dcr.0000000000001679CrossRefPubMed

Addison P, Agnew JL, Martz J (2020) Robotic colorectal surgery. Surg Clin N Am 100:337–360. https://doi.org/10.1016/j.suc.2019.12.012CrossRefPubMed

10.

Cleary RK, Silviera M, Reidy TJ et al (2022) Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial. Surg Endosc 36:4349–4358. https://doi.org/10.1007/s00464-021-08780-9CrossRefPubMed

11.

Carnuccio P, Jimeno J, Parés D (2014) Laparoscopic right colectomy: a systematic review and meta-analysis of observational studies comparing two types of anastomosis. Tech Coloproctol 18:5–12. https://doi.org/10.1007/s10151-013-1029-4CrossRefPubMed

12.

Zhang H, Sun N, Fu Y, Zhao C (2021) Intracorporeal versus extracorporeal anastomosis in laparoscopic right colectomy: updated meta-analysis of randomized controlled trials. BJS Open 5:zrab133. https://doi.org/10.1093/bjsopen/zrab133CrossRefPubMedPubMedCentral

13.

Jalil SA, Jalil AAA, Groening R, Biswas S (2021) Robotic versus laparoscopic colorectal resection: are we there yet? Cureus 13:e19698. https://doi.org/10.7759/cureus.19698CrossRefPubMedPubMedCentral

14.

Feroci F, Lenzi E, Garzi A et al (2013) Intracorporeal versus extracorporeal anastomosis after laparoscopic right hemicolectomy for cancer: a systematic review and meta-analysis. Int J Colorectal Dis 28:1177–1186. https://doi.org/10.1007/s00384-013-1651-7CrossRefPubMed

15.

Ricci C, Casadei R, Alagna V et al (2017) A critical and comprehensive systematic review and meta-analysis of studies comparing intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy. Langenbecks Arch Surg 402:417–427. https://doi.org/10.1007/s00423-016-1509-xCrossRefPubMed

16.

Akram WM, Al-Natour RH, Albright J et al (2018) A propensity score-matched comparison of intracorporeal and extracorporeal techniques for robotic-assisted right colectomy in an enhanced recovery pathway. Am J Surg 216:1095–1100. https://doi.org/10.1016/j.amjsurg.2018.06.010CrossRefPubMed

17.

Shea BJ, Reeves BC, Wells G et al (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008. https://doi.org/10.1136/bmj.j4008CrossRefPubMedPubMedCentral

18.

Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. https://doi.org/10.1186/2046-4053-4-1CrossRefPubMedPubMedCentral

19.

Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919CrossRefPubMedPubMedCentral

20.

Cardinali L, Belfiori G, Ghiselli R et al (2016) Robotic versus laparoscopic right colectomy for cancer: short-term outcomes and influence of body mass index on conversion rate. Minerva Chir 71:217–222PubMed

21.

Hopkins MB, Hawkins AT, Tiwari V et al (2022) Is newer always better? Comparing cost and short-term outcomes between laparoscopic and robotic right hemicolectomy. Surg Endosc 36:2879–2885. https://doi.org/10.1007/s00464-021-08579-8CrossRefPubMed

22.

Kelley SR, Duchalais E, Larson DW (2018) Short-term outcomes with robotic right colectomy. Am Surg 84:1768–1773CrossRefPubMed

23.

Khan JS, Ahmad A, Odermatt M et al (2021) Robotic complete mesocolic excision with central vascular ligation for right colonic tumours – a propensity score-matching study comparing with standard laparoscopy. BJS Open 5:zrab016. https://doi.org/10.1093/bjsopen/zrab016CrossRefPubMedPubMedCentral

24.

Lujan HJ, Plasencia G, Rivera BX et al (2018) Advantages of robotic right colectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percutaneous Tech 28:36–41. https://doi.org/10.1097/sle.0000000000000384CrossRef

25.

Morpurgo E, Contardo T, Molaro R et al (2013) Robotic-assisted intracorporeal anastomosis versus extracorporeal anastomosis in laparoscopic right hemicolectomy for cancer: a case control study. J Laparoendosc Adv S 23:414–417. https://doi.org/10.1089/lap.2012.0404CrossRef

26.

Rattenborg S, Bundgaard L, Andersen J et al (2021) Intracorporeal anastomosis in right hemicolectomy for colon cancer: short-term outcomes with the DaVinci Xi robot. J Robotic Surg 15:915–922. https://doi.org/10.1007/s11701-020-01188-yCrossRef

27.

Scotton G, Contardo T, Zerbinati A et al (2018) From laparoscopic right colectomy with extracorporeal anastomosis to robot-assisted intracorporeal anastomosis to totally robotic right colectomy for cancer: the evolution of robotic multiquadrant abdominal surgery. J Laparoendosc Adv S 28:1216–1222. https://doi.org/10.1089/lap.2017.0693CrossRef

28.

Trastulli S, Coratti A, Guarino S et al (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29:1512–1521. https://doi.org/10.1007/s00464-014-3835-9CrossRefPubMed

29.

Blumberg D (2019) Robotic colectomy with intracorporeal anastomosis is feasible with no operative conversions during the learning curve for an experienced laparoscopic surgeon developing a robotics program. J Robot Surg 13:545–555. https://doi.org/10.1007/s11701-018-0895-1CrossRefPubMed

30.

Ceccarelli G, Costa G, Ferraro V et al (2021) Robotic or three-dimensional (3D) laparoscopy for right colectomy with complete mesocolic excision (CME) and intracorporeal anastomosis? A propensity score-matching study comparison. Surg Endosc 35:2039–2048. https://doi.org/10.1007/s00464-020-07600-wCrossRefPubMed

31.

Merola G, Sciuto A, Pirozzi F et al (2020) Is robotic right colectomy economically sustainable? a multicentre retrospective comparative study and cost analysis. Surg Endosc 34:4041–4047. https://doi.org/10.1007/s00464-019-07193-zCrossRefPubMed

32.

Migliore M, Giuffrida MC, Marano A et al (2021) Robotic versus laparoscopic right colectomy within a systematic ERAS protocol: a propensity-weighted analysis. Updat Surg 73:1057–1064. https://doi.org/10.1007/s13304-020-00722-9CrossRef

33.

Ngu JC-Y, Ng YY-R (2018) Robotics confers an advantage in right hemicolectomy with intracorporeal anastomosis when matched against conventional laparoscopy. J Robotic Surg 12:647–653. https://doi.org/10.1007/s11701-018-0793-6CrossRef

34.

Solaini L, Cavaliere D, Pecchini F et al (2019) Robotic versus laparoscopic right colectomy with intracorporeal anastomosis: a multicenter comparative analysis on short-term outcomes. Surg Endosc 33:1898–1902. https://doi.org/10.1007/s00464-018-6469-5CrossRefPubMed

35.

Spinoglio G, Bianchi PP, Marano A et al (2018) Robotic versus laparoscopic right colectomy with complete mesocolic excision for the treatment of colon cancer: perioperative outcomes and 5-year survival in a consecutive series of 202 patients. Ann Surg Oncol 25:3580–3586. https://doi.org/10.1245/s10434-018-6752-7CrossRefPubMed

36.

Gerbaud F, Valverde A, Danoussou D et al (2019) Experience with transitioning from laparoscopic to robotic right colectomy. JSLS 23:e2019.00044. https://doi.org/10.4293/jsls.2019.00044CrossRefPubMedPubMedCentral

37.

Reitz ACW, Lin E, Rosen SA (2018) A single surgeon’s experience transitioning to robotic-assisted right colectomy with intracorporeal anastomosis. Surg Endosc 32:3525–3532. https://doi.org/10.1007/s00464-018-6074-7CrossRefPubMed

38.

Widmar M, Aggarwal P, Keskin M et al (2020) Intracorporeal anastomoses in minimally invasive right colectomies are associated with fewer incisional hernias and shorter length of stay. Dis Colon Rectum 63:685–692. https://doi.org/10.1097/dcr.0000000000001612CrossRefPubMedPubMedCentral

39.

Ahmadi N, Mor I, Warner R (2022) Comparison of outcome and costs of robotic and laparoscopic right hemicolectomies. J Robotic Surg 16:429–436. https://doi.org/10.1007/s11701-021-01246-zCrossRef

40.

Zhang X, Wang Z, Chen J et al (2020) Incidence and risk factors of surgical site infection following colorectal surgery in China: a national cross-sectional study. BMC Infect Dis 20:837. https://doi.org/10.1186/s12879-020-05567-6CrossRefPubMedPubMedCentral

41.

Martinek L, You K, Giuratrabocchetta S et al (2018) Does laparoscopic intracorporeal ileocolic anastomosis decreases surgical site infection rate? A propensity score-matched cohort study. Int J Colorectal Dis 33:291–298. https://doi.org/10.1007/s00384-017-2957-7CrossRefPubMed

42.

van Oostendorp S, Elfrink A, Borstlap W et al (2017) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc 31:64–77. https://doi.org/10.1007/s00464-016-4982-yCrossRefPubMed

43.

Gass J-M, Daume D, Schneider R et al (2022) Laparoscopic versus robotic-assisted, left-sided colectomies: intra- and postoperative outcomes of 683 patients. Surg Endosc 36:6235–6242. https://doi.org/10.1007/s00464-021-09003-xCrossRefPubMedPubMedCentral

44.

de’Angelis N, Lizzi V, Azoulay D, Brunetti F (2016) Robotic versus laparoscopic right colectomy for colon cancer: analysis of the initial simultaneous learning curve of a surgical fellow. J Laparoendosc Adv S 26:882–892. https://doi.org/10.1089/lap.2016.0321CrossRef

45.

Widmar M, Keskin M, Beltran P et al (2016) Incisional hernias after laparoscopic and robotic right colectomy. Hernia 20:723–728. https://doi.org/10.1007/s10029-016-1518-2CrossRefPubMedPubMedCentral

46.

Wick EC, Shore AD, Hirose K et al (2011) Readmission rates and cost following colorectal surgery. Dis Colon Rectum 54:1475–1479. https://doi.org/10.1097/dcr.0b013e31822ff8f0CrossRefPubMed

47.

Dohrn N, Yikilmaz H, Laursen M et al (2022) Intracorporeal versus extracorporeal anastomosis in robotic right colectomy. Ann Surg 276:e294–e301. https://doi.org/10.1097/sla.0000000000005254CrossRefPubMed

Title: Intracorporeal or extracorporeal anastomosis after minimally invasive right colectomy: a systematic review and meta-analysis
Authors: A. I. Squillaro
J. Kohn
L. Weaver
A. Yankovsky
G. Milky
N. Patel
U. S. Kreaden
W. B. Gaertner
Publication date: 10-08-2023
Publisher: Springer International Publishing
Keywords: Colectomy
Colectomy
Minimally Invasive Surgery
Published in: Techniques in Coloproctology / Issue 11/2023
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-023-02850-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intracorporeal or extracorporeal anastomosis after minimally invasive right colectomy: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2023

Functional outcomes after transanal total mesorectal excision (TaTME): a random forest analysis to predict patients’ outcomes

How do you manage the peritoneal opening during TAMIS procedure?

Laparoscopic posterior pelvic exenteration is safe and feasible for locally advanced primary rectal cancer in female patients: a comparative study from China PelvEx collaborative

Mixed adenoneuroendocrine carcinoma originating from the appendix and colorectum: a comparative analysis of a large population-based database

Robotic abdominoperineal resection, posterior vaginectomy and abdomino-lithotomy sacrectomy: technical considerations and case vignette

Segmental and extended resections provide comparable survival for clinically node-negative splenic flexure cancer: a propensity score-matched analysis of the National Cancer Database