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Page 2 of 16 Park et al. Mini-invasive Surg 2020;4:87 I http://dx.doi.org/10.20517/2574-1225.2020.87

(OR = 0.52; 95%CI: 0.31-0.85; P = 0.009). The number of lymph nodes harvested was higher in IA (MD = 1.05;
2
95%CI: 0.19-1.91; P = 0.02; I = 83%) with considerable heterogeneity.

Conclusion: Intracorporeal anastomosis can be considered a safe alternative technique in laparoscopic colectomies,
with potential benefits in patient outcomes. A lack of randomised studies and heterogeneity need to be addressed
by additional high-quality trials.

Keywords: Laparoscopic, intracorporeal, extracorporeal, colectomy, outcome

INTRODUCTION
Laparoscopic colectomy has been increasingly performed worldwide since its introduction and it is
[1]
currently considered the “gold standard” surgical care for benign and malignant colon resections . The
most common indication for the colon resection is malignancy, which is the second leading cause of cancer
[2]
death worldwide, with a lifetime incidence of approximately 6% .
In general, the term “laparoscopic colectomy” refers to laparoscopic-assisted colectomy with extracorporeal
anastomosis (EA). Extracorporeal anastomosis is the preferred technique as intracorporeal anastomosis
(IA) is considered more technically challenging due to the need for laparoscopic suturing and the potential
[3,4]
risk of intra-abdominal spillage . Subsequently, there has been concern about a greater likelihood of
anastomotic leak . However, IA is less invasive, and there is accumulating data to support its safety and
[5]
[6,7]
potential short-term benefits in the post-operative period . Unfortunately, available meta-analyses are
limited to right colectomies based on limited observational studies while there is a paucity of data on left
colectomies.

Traditionally, left colectomy is perceived to be more challenging than right colectomy due to the need for
extensive posterior dissection during mobilisation of the splenic flexure and its anatomic characteristics
[8]
of multiple lymphatic drainage. However, a study by Iorio et al. , investigating direct comparison of
surgical outcomes in laparoscopic IA approach between right-sided and left-sided tumours, concluded
that the location of the tumour itself did not have significant impact on patient clinical outcome, including
anastomotic leakage.

The aim of this study was, therefore, to conduct a comprehensive systematic review to perform a combined
meta-analysis of left and right-sided colectomies in order to broaden the existing understanding on the
safety and potential benefits of IA in laparoscopic colectomy, irrespective of its primary location.

METHODS
Study design
Literature search and data extraction
A systematic literature search was carried out by two independent researchers using electronic databases
including Medline, EMBASE, Cochrane Library, and PubMed. The following search strategy was
used for database extraction using Endnote (Version X8, Clarivate Analytics®): “intracorporeal” OR
“extracorporeal” OR “anastomosis” OR “laparoscopic assisted” OR “totally laparoscopic” AND “colectomy”
and (“laparoscopy” or “laparoscopic”). The search was performed without any restriction on language or
publication status. Studies published in a language other than English were excluded unless its full article
was available in an English edition.