Ann Surg Treat Res.  2016 Oct;91(4):195-201. 10.4174/astr.2016.91.4.195.

Reduced port laparoscopic surgery for colon cancer is safe and feasible in terms of short-term outcomes: comparative study with conventional multiport laparoscopic surgery

• Song JM
• Kim JH
• Lee YS
• Kim HY
• Lee IK
• Oh ST
• Kim JG

• KMID: 2354327
• DOI: http://doi.org/10.4174/astr.2016.91.4.195

Abstract

PURPOSE
Laparoscopic surgery was previously accepted as an alternative surgical option in treatment for colorectal cancer. Nowadays, single-port laparoscopic surgery (SPLS) is introduced as a method to maximize advantages of minimally invasive surgery. However, SPLS has several limitations compared to conventional multiport laparoscopic surgery (CMLS). To overcome those limitations of SPLS, reduced port laparoscopic surgery (RPLS) was introduced. This study aimed at evaluating the short-term outcomes of RPLS.
METHODS
Patients who underwent CMLS and RPLS of colon cancer between August 2011 and December 2013 were included in this study. Short-term clinical and pathological outcome were compared between the 2 groups.
RESULTS
Thirty-two patients underwent RPLS and 217 patients underwent CMLS. Shorter operation time, less blood loss, and faster bowel movement were shown in RPLS group in this study. In terms of postoperative pain, numeric rating scale (NRS) of RPLS was lower than that of CMLS. Significant differences were shown in terms of tumor size, harvested lymph node, perineural invasion, and pathological stage. No significant differences were confirmed in terms of other surgical outcomes.
CONCLUSION
In this study, RPLS was technically feasible and safe. Especially in terms of postoperative pain, RPLS was comparable to CMLS. RPLS may be a feasible alternative option in selected patients with colon cancer.

Keyword

Colon cancer; Laparoscopic surgery; Minimally invasive surgery

MeSH Terms

Colon*
Colonic Neoplasms*
Colorectal Neoplasms
Humans
Laparoscopy*
Lymph Nodes
Methods
Minimally Invasive Surgical Procedures
Pain, Postoperative

Figure

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  Figure. 1 Trocars placement of reduced port laparoscopic surgery for colon cancer. (A) Trocars placement in right-side colon cancer. (B) Trocars placement in left-side colon cancer.

Reference

1. Lorenzon L, La Torre M, Ziparo V, Montebelli F, Mercantini P, Balducci G, et al. Evidence based medicine and surgical approaches for colon cancer: evidences, benefits and limitations of the laparoscopic vs open resection. World J Gastroenterol. 2014; 20:3680–3692.

2. Scarpa M, Erroi F, Ruffolo C, Mollica E, Polese L, Pozza G, et al. Minimally invasive surgery for colorectal cancer: quality of life, body image, cosmesis, and functional results. Surg Endosc. 2009; 23:577–582.

3. Baek JH, Lee GJ, Lee WS. Comparison of long-term oncologic outcomes of stage III colorectal cancer following laparoscopic versus open surgery. Ann Surg Treat Res. 2015; 88:8–14.

4. Sammour T, Jones IT, Gibbs P, Chandra R, Steel MC, Shedda SM, et al. Comparing oncological outcomes of laparoscopic versus open surgery for colon cancer: analysis of a large prospective clinical database. J Surg Oncol. 2015; 111:891–898.

5. Cianchi F, Trallori G, Mallardi B, Macri G, Biagini MR, Lami G, et al. Survival after laparoscopic and open surgery for colon cancer: a comparative, single-institution study. BMC Surg. 2015; 15:33.

6. 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.

7. Egi H, Hattori M, Hinoi T, Takakura Y, Kawaguchi Y, Shimomura M, et al. Single-port laparoscopic colectomy versus conventional laparoscopic colectomy for colon cancer: a comparison of surgical results. World J Surg Oncol. 2012; 10:61.

8. Papaconstantinou HT, Thomas JS. Single-incision laparoscopic colectomy for cancer: assessment of oncologic resection and short-term outcomes in a case-matched comparison with standard laparoscopy. Surgery. 2011; 150:820–827.

9. 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.

10. Kim IY, Kim BR, Kim YW. The short-term and oncologic outcomes of laparoscopic versus open surgery for T4 colon cancer. Surg Endosc. 2016; 30:1508–1518.

11. Allaix ME, Giraudo G, Mistrangelo M, Arezzo A, Morino M. Laparoscopic versus open resection for colon cancer: 10-year outcomes of a prospective clinical trial. Surg Endosc. 2015; 29:916–924.

12. Zeng WG, Liu MJ, Zhou ZX, Hou HR, Liang JW, Wang Z, et al. Outcome of laparoscopic versus open resection for transverse colon cancer. J Gastrointest Surg. 2015; 19:1869–1874.

13. Wang CL, Qu G, Xu HW. The short- and long-term outcomes of laparoscopic versus open surgery for colorectal cancer: a meta-analysis. Int J Colorectal Dis. 2014; 29:309–320.

14. Desiderio J, Trastulli S, Ricci F, Penzo J, Cirocchi R, Farinacci F, et al. Laparoscopic versus open left colectomy in patients with sigmoid colon cancer: prospective cohort study with long-term follow-up. Int J Surg. 2014; 12:745–750.

15. Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Azuma D, Kohama S. Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases. Surg Endosc. 2016; 30:1317–1325.

16. Tei M, Wakasugi M, Akamatsu H. Comparison of perioperative and short-term oncological outcomes after single- or multiport surgery for colorectal cancer. Colorectal Dis. 2015; 17:O141–O147.

17. Markar SR, Wiggins T, Penna M, Paraskeva P. Single-incision versus conventional multiport laparoscopic colorectal surgery-systematic review and pooled analysis. J Gastrointest Surg. 2014; 18:2214–2227.

18. Levic K, Bulut O. The short-term outcomes of conventional and single-port laparoscopic surgery for rectal cancer: a comparative non-randomized study. Minim Invasive Ther Allied Technol. 2014; 23:214–222.

19. 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.

20. Yun JA, Kim HC, Park JS, Cho YB, Yun SH, Lee WY. Perioperative and oncologic outcomes of single-incision laparoscopy compared with conventional laparoscopy for colon cancer: an observational propensity score-matched study. Am Surg. 2015; 81:316–323.

21. Gash K, Bicsak M, Dixon A. Single-incision laparoscopic surgery for rectal cancer: early results and medium-term oncological outcome. Colorectal Dis. 2015; 17:1071–1078.

22. Uematsu D, Akiyama G, Narita M, Magishi A. Single-access laparoscopic low anterior resection with vertical suspension of the rectum. Dis Colon Rectum. 2011; 54:632–637.

23. Kwag SJ, Kim JG, Oh ST, Kang WK. Single incision vs conventional laparoscopic anterior resection for sigmoid colon cancer: a case-matched study. Am J Surg. 2013; 206:320–325.

24. Lim SW, Kim HR, Kim YJ. Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy. Ann Surg Treat Res. 2014; 87:131–138.

25. 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.

26. Kawamata F, Homma S, Minagawa N, Kawamura H, Takahashi N, Taketomi A. Comparison of single-incision plus one additional port laparoscopy-assisted anterior resection with conventional laparoscopy-assisted anterior resection for rectal cancer. World J Surg. 2014; 38:2716–2723.

27. Kim JS, Cho SY, Min BS, Kim NK. Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg. 2009; 209:694–701.

28. Wolthuis AM, Penninckx F, Fieuws S, D'Hoore A. Outcomes for case-matched single-port colectomy are comparable with conventional laparoscopic colectomy. Colorectal Dis. 2012; 14:634–641.

29. Kim SJ, Choi BJ, Lee SC. Successful total shift from multiport to single-port laparoscopic surgery in low anterior resection of colorectal cancer. Surg Endosc. 2014; 28:2920–2930.

30. Park SJ, Lee KY, Kang BM, Choi SI, Lee SH. Initial experience of single-port laparoscopic surgery for sigmoid colon cancer. World J Surg. 2013; 37:652–656.