Ann Surg Treat Res.  2014 Sep;87(3):131-138. 10.4174/astr.2014.87.3.131.

Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy

• Lim SW
• Kim HR
• Kim YJ

• KMID: 1908483
• DOI: http://doi.org/10.4174/astr.2014.87.3.131

Abstract

PURPOSE
The aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer.
METHODS
Forty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012.
RESULTS
In the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes).
CONCLUSION
SILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time.

Keyword

Single incision; Laparoscopic surgery; Colorectal neoplasms

MeSH Terms

Adenocarcinoma
Colectomy*
Colorectal Neoplasms*
Humans
Laparoscopy
Multivariate Analysis
Operative Time
Rectal Neoplasms
Rectum
Retrospective Studies
Risk Factors

Reference

1. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004; 350:2050–2059.

2. Akmal Y, Bailey C, Baek JH, Metchikian M, Pigazzi A. Oncological outcomes of laparoscopic colon resection for cancer after implementation of a full-time preceptorship. Surg Endosc. 2011; 25:2967–2971.

3. Braga M, Frasson M, Zuliani W, Vignali A, Pecorelli N, Di Carlo V. Randomized clinical trial of laparoscopic versus open left colonic resection. Br J Surg. 2010; 97:1180–1186.

4. Kang SB, Park JW, Jeong SY, Nam BH, Choi HS, Kim DW, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010; 11:637–645.

5. Laurent C, Leblanc F, Wutrich P, Scheffler M, Rullier E. Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg. 2009; 250:54–61.

6. Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, et al. The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg. 2008; 248:1–7.

7. Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Weiss H. Single incision laparoscopic sigmoid colon resections without visible scar: a novel technique. Colorectal Dis. 2010; 12:66–70.

8. Adair J, Gromski MA, Lim RB, Nagle D. Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport laparoscopic right colectomy. Dis Colon Rectum. 2010; 53:1549–1554.

9. Chambers WM, Bicsak M, Lamparelli M, Dixon AR. Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis. 2011; 13:393–398.

10. Remzi FH, Kirat HT, Geisler DP. Laparoscopic single-port colectomy for sigmoid cancer. Tech Coloproctol. 2010; 14:253–255.

11. Fujii S, Watanabe K, Ota M, Watanabe J, Ichikawa Y, Yamagishi S, et al. Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case-control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost. Surg Endosc. 2012; 26:1403–1411.

12. Geisler D, Garrett T. Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases. Tech Coloproctol. 2011; 15:397–401.

13. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.

14. Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR. Umbilical incision laparoscopic colectomy with one additional port for colorectal cancer. Tech Coloproctol. 2013; 17:193–199.

15. Lai CW, Edwards TJ, Clements DM, Coleman MG. Single port laparoscopic right colonic resection using a 'vessel-first' approach. Colorectal Dis. 2012; 14:1138–1144.

16. Papaconstantinou HT, Sharp N, Thomas JS. Single-incision laparoscopic right colectomy: a case-matched comparison with standard laparoscopic and hand-assisted laparoscopic techniques. J Am Coll Surg. 2011; 213:72–80.

17. Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC, et al. The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg. 2011; 254:933–940.

18. Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP. Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum. 2011; 54:183–186.

19. Law WL, Fan JK, Poon JT. Single-incision laparoscopic colectomy: early experience. Dis Colon Rectum. 2010; 53:284–288.

20. Makino T, Milsom JW, Lee SW. Feasibility and safety of single-incision laparoscopic colectomy: a systematic review. Ann Surg. 2012; 255:667–676.

21. Bulut O, Nielsen CB, Jespersen N. Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases. Dis Colon Rectum. 2011; 54:803–809.

22. Bulut O, Nielsen CB. Single-incision laparoscopic low anterior resection for rectal cancer. Int J Colorectal Dis. 2010; 25:1261–1263.

23. Dumont F, Goere D, Honore C, Elias D. Transanal endoscopic total mesorectal excision combined with single-port laparoscopy. Dis Colon Rectum. 2012; 55:996–1001.

24. Gaujoux S, Bretagnol F, Au J, Ferron M, Panis Y. Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach. Colorectal Dis. 2011; 13:e305–e307.

25. Zhang H, Zhang YS, Jin XW, Li MZ, Fan JS, Yang ZH. Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol. 2013; 17:117–123.

26. Champagne BJ, Papaconstantinou HT, Parmar SS, Nagle DA, Young-Fadok TM, Lee EC, et al. Single-incision versus standard multiport laparoscopic colectomy: a multicenter, case-controlled comparison. Ann Surg. 2012; 255:66–69.

27. Poon JT, Cheung CW, Fan JK, Lo OS, Law WL. Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc. 2012; 26:2729–2734.

28. Gandhi DP, Ragupathi M, Patel CB, Ramos-Valadez DI, Pickron TB, Haas EM. Single-incision versus hand-assisted laparoscopic colectomy: a case-matched series. J Gastrointest Surg. 2010; 14:1875–1880.

29. Leblanc F, Champagne BJ, Augestad KM, Stein SL, Marderstein E, Reynolds HL, et al. Single incision laparoscopic colectomy: technical aspects, feasibility, and expected benefits. Diagn Ther Endosc. 2010; 2010:913216.

30. Vasilakis V, Clark CE, Liasis L, Papaconstantinou HT. Noncosmetic benefits of single-incision laparoscopic sigmoid colectomy for diverticular disease: a case-matched comparison with multiport laparoscopic technique. J Surg Res. 2013; 180:201–207.