Yes, it is time for wider uptake for intracorporeal anastomosis for minimally invasive right colectomy

We greatly appreciated perspective study by Phan-Thien et al.’s “Intracorporeal anastomosis for minimally invasive right colectomy – is it time for wider uptake?”. Scientific literature still considers Intracorporeal anstomosis (ICA) for minimally invasive right colectomy as challenging issue, although data seem to support its wider applicability. A systematic review and meta-analysis by Zheng et al. analysed 30 papers (17 retrospective-, 7 prospective-, 3 randomized control trials and 3 case–control studies) comparing 4317 patients, who underwent laparoscopic right emicolectomy (1948 with ICA and 2369 with extracorporeal anastomosis—ECA). Authors proved ICA was related to a lower volume of intraoperative blood loss (P < 0.01), earlier bowel recovery associated with shorter time to first flatus (P < 0.01) and first defecation (P < 0.01), in addition to lower conversion rate (P = 0.02), shorter length of hospitalization (P < 0.01), shorter incision length (P < 0.01) and less frequent rate of wound infection (P < 0.01). Zheng et al. did not find any discrepancies either in operation times, number of harvested lymph nodes, anastomotic leakage and ileus (P > 0.05). A systematic review and meta-analysis by Liang et al. evaluated a total of five observational cohort studies, by comparing 585 patients who underwent robotic right emicolectomy. Authors recorded a lower rate of anastomotic leak (P = 0.03), shorter time to first flatus (P = 0.003) and also longer operative time (P = 0.0002). Updated meta-analysis that included five randomized controlled trials by Zhang et al. and compared 559 patients found ICA as associated with shorter time to first flatus (P = 0.0005) and first stool passage (P < 0.00001), visual analogue pain scale on postoperative day (POD) 3/4/5 (P = 0.002, P = 0.01, P = 0.0007), length of incision (P = 0.0001) and wound infection (P = 0.02). The most recent scientific studies highlight ICA safety and higher effectiveness when compared to ECA in right emicolectomy. Therefore, as Phan-Thien et al. suggested, a more frequent use of such anastomotic method would be strongly recommended.