Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Colectomy for Colorectal Cancer: A Systematic Review and Meta-Analysis of Oncologic Outcomes

Abstract

Background & Objective: Laparoscopic colectomy is a standard approach for surgical management of colorectal cancer, but the choice of extracorporeal anastomosis (EA) and intracorporeal anastomosis (IA) remains a key technical decision during this procedure. The oncological outcomes are limited and not consistent, though several studies have compared their perioperative outcomes. This meta-analysis intended to compare overall survival (OS), disease-free survival, and cancer recurrence between IA and EA in patients undergoing laparoscopic colectomy for colorectal cancer, with subgroup analysis of tumor location (right-sided vs left-sided). Methodology: Randomized controlled trials and cohort studies with a follow-up period of two years comparing IA vs EA were eligible for inclusion. To identify these, PubMed, Cochrane, Scopus, and Embase were used with no publication restriction up to 16 July 2026. 2184 records were screened out, of which 119 texts were accessed for eligibility. 80 were excluded, which did not meet the PICO or follow-up criteria. 39 were secondary screened, of which 12 studies met the inclusion criteria for quantitative analysis. Results: Pooled analysis showed a non-significant trend favoring IA for overall survival (HR 0.72, 95% CI 0.50–1.03) and disease-free survival (HR 0.80, 95% CI 0.62–1.04), while recurrence rates were similar between groups (RR 1.01, 95% CI 0.69–1.49). No specific subgroup differences emerged between left- and right-sided colectomies (p>0.05 for all comparisons); OS hazard ratios were similar in direction for both — 0.69 (95% CI 0.44–1.09) on the right and 0.78 (95% CI 0.42–1.43) on the left. Heterogeneity was low to absent across all pooled outcomes (I²=0%). Conclusion: Intracorporeal anastomosis shows a consistent but statistically non-significant trend towards improved long-term survival compared with extracorporeal anastomosis in laparoscopic colectomy for colorectal cancer, with no significant difference in recurrence risk between the two regarding the tumor locations. Confirming whether the survival advantage is real will require suitably powered prospective trials designed specifically for this comparison. Key Words: Intracorporal anastomosis, Extra Corporal Anastomosis, Laparoscopic colectomy, Colorectal Cancer.