Abstract
Background
The feasibility and effectiveness of selecting an intracorporeal or extracorporeal technique in left hemicolectomy remain poorly understood. This meta-analysis aimed to evaluate the difference between the two approaches regarding intraoperative and postoperative outcomes.
Methods
A thorough exploration of online databases (PubMed, Embase, Cochrane, and Web of Science) was executed to identify randomized controlled trials, cohort studies, and case control studies. The outcomes contained four aspects: intraoperative outcomes, postoperative complications, postoperative patient conditions, and postoperative outcomes. All of these data were analyzed using RevMan 5.4. Seven retrospective control trials (intracorporeal, 396 patients; extracorporeal, 426 patients) were evaluated.
Results
Compared to the extracorporeal group, the intracorporeal group demonstrated superiority in incision length (P = 0.005), overall complications (P = 0.01), time to first flatus (P < 0.001), time to first stool (P = 0.005), time to first diet (P < 0.001) and hospital stay duration (P = 0.001).
Conclusions
The intracorporeal technique is associated with superiority over the extracorporeal technique in reducing postoperative complications, promoting postoperative recovery of gastrointestinal function, and reducing hospital stay duration.
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Data availability
The dataset generated during this systematic review is available from the corresponding author on reasonable request.
Abbreviations
- IA:
-
Intracorporeal anastomosis
- EA:
-
Extracorporeal anastomosis
- CRC:
-
Colorectal cancer
- MeSH:
-
Medical Subject Headings
- NOS:
-
Newcastle–Ottawa Scale
- OR:
-
Odds ratio
- SMD:
-
Standardized mean difference
- PRISMA:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- BMI:
-
Body mass index
- REC:
-
Representativeness of the exposed cohort
- SNEC:
-
Selection of the nonexposed cohort
- AE:
-
Ascertainment of exposure
- DO:
-
Demonstration that outcome of interest was not present at start of study
- SC:
-
Study controls for age, sex
- AF:
-
Study controls for any additional factors
- AO:
-
Assessment of outcome
- FU:
-
Follow-up long enough (36 M) for outcomes to occur
- AFU:
-
Adequacy of follow-up of cohorts
- SR:
-
Standard error
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Acknowledgements
We sincerely thank all the participants for their help in this study. Thanks to Dalian Medical University, Northern Jiangsu People's Hospital.
Funding
This work was supported by [Galectin-1 and GRP78 interact in the endoplasmic reticulum to activate mesenchymal CAFs and promote the invasion and metastasis of gastric cancer through ATF4-SHH pathway] (81972269) and [Key Laboratory of Basic and Clinical Translation of Digestive/Metabolic Diseases] (YZ2020159).
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Concept and design, QY and Y-YF. Collection and assembly of data, QY, Y-YF, Q-NS. Data analysis and interpretation, JR and L-HW. Manuscript writing, Q Y and D-RW. The authors read and approved the final manuscript.
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The study was not ethically reviewed, and there were no participants involved in the present study.
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Yao, Q., Fu, YY., Sun, QN. et al. Comparison of intracorporeal and extracorporeal anastomosis in left hemicolectomy: updated meta-analysis of retrospective control trials. J Cancer Res Clin Oncol 149, 14341–14351 (2023). https://doi.org/10.1007/s00432-023-05091-5
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DOI: https://doi.org/10.1007/s00432-023-05091-5