Abstract
Background
The aim of this study was to reveal the short-term and long-term outcomes of single-incision laparoscopic colorectal resection (SILC) compared with multi-incision laparoscopic colorectal resection (MILC) for colorectal cancer using propensity score matching analysis.
Methods
The study group included 235 patients who underwent SILC and 730 patients who underwent MILC for colorectal cancer between April 2009 and September 2014. The propensity score matching for age, gender, body mass index, tumor location (right-sided colon/sigmoid colon/upper rectum), lymph node dissection (D1/D2/D3), pathologic T (≤T3) stage and TNM (0–I/II/III) stage produced 107 matched pairs. The exclusion criteria for SILC were as follows: (1) tumors located at the transverse, descending colon or lower rectum, (2) stage IV tumors, synchronous or previous malignancies, (3) locally advanced tumors >T4, (4) acute obstructions or previous major abdominal surgery and (5) obese patients: BMI > 30.
Results
No significant differences were observed in operating time, bleeding volumes, starting time of liquid diet and length of hospital stay between the SILC and MILC groups. However, the SILC group showed less analgesic requirements (1.1 vs. 1.9 times; p = 0.0006) and shorter length of incision (2.7 vs. 4.3 cm; p = 0.0000) compared to MILC group. The overall rate of postoperative complications was similar in both groups (2.8 vs. 3.7 %, p = 0.70). The 5-year overall survival rate of SILC and MILC was 100 and 95 % (p = 0.125) and 5-year disease-free survival rates in stages 0–III were 97 and 94 % (p = 0.189), 100 and 92 % in stage II and 90 and 85 % in stage III, respectively.
Conclusions
This study suggests that SILC for colorectal cancer is a safe and feasible option with better cosmetic results and less pain in strictly selected patients. SILC can also produce good oncological results with similar postoperative outcomes to MILC.
Similar content being viewed by others
References
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229
Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248(1):1–7
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group (2005) Short term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled trial. Lancet 365:1718–1726
Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM, UK MRC CLASICC Trial Group (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM, COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484
Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826
Leroy J et al (2009) Single access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144:173–179
Chambers W, Bicsak M, Lamparelli M, Dixon A (2011) Single incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 13:393–398
Ramos-Valadez DI, Patel CB, Ragupathi M, Bartley Pickron T, Haas EM (2010) Single-incision laparoscopic right hemicolectomy: safety and feasibility in a series of consecutive cases. Surg Endosc 24:2613–2616
Bucher P, Pugin F, Morel P (2009) Single-port access laparoscopic radical left colectomy in humans. Dis Colon Rectum 52:1797–1801
Boni L, Dionigi G, Cassinotti E, Di Giuseppe M, Diurni M, Rausei S, Cantore F, Dionigi R (2010) Single incision laparoscopic right colectomy. Surg Endosc 24:3233–3236
Merchant AM, Lin E (2009) Single-incision laparoscopic right hemicolectomy for a colon mass. Dis Colon Rectum 52:1021–1024
Patel CB, Ramos-Valadez DI, Ragupathi M, Hass EM (2010) Single incision laparoscopic-assisted right hemicolectomy: technique and application (with video). Surg Laparosc Endosc Percutan Tech 20:e146–e149. doi:10.1097/SLE.0b013e3181ee039f
Adair J, Gromski MA, Lim RB, Nagle D (2010) Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport right colectomy. Dis Colon Rectum 53:1549–1554
Waters JA, Guzman MJ, Fajardo AD, Selzer DJ, Wiebke EA, Robb BW, George VV (2010) Single-port laparoscopic right hemicolectomy: a safe alternative to conventional laparoscopy. Dis Colon Rectum 53:1467–1472
Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Ouchi M, Hirasaki Y (2011) Single-incision laparoscopic colectomy for colon cancer: early experience with 31 cases. Dis Colon Rectum 54:705–710
Vestweber B, Galetin T, Lammerting K, Paul C, Giehl J, Straub E, Kaldowski B, Alfes A, Vestweber KH (2013) Single incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS. Surg Endosc 27:434–442
Papaconstantinou HT, Sharp N, Thomas JS (2011) Single-incision laparoscopic right colectomy: a case-matched comparison with standard laparoscopic and hand-assisted laparoscopic techniques. J Am Coll Surg 213:72–82
Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP (2011) Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum 54:183–186
Lee SW, Milsom JW, Nash GM (2011) Single-incision versus multiport laparoscopic right and hand-assisted left colectomy: a case-matched comparison. Dis Colon Rectum 54:1355–1361
Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC, Oh ST (2011) The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg 254(6):933–940
Chen WT, Chang SC, Chiang HC, Lo WY, Jeng LB, Wu C, Ke TW (2011) Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc 25:1887–1892
Champagne BJ, Papaconstantinou HT, Parmar SS, Nagle DA, Young-Fadok TM, Lee EC, Delaney CP (2012) Single incision versus standard multiport laparoscopic colectomy: a multicenter, case-controlled comparison. Ann Surg 255(1):66–69
Ramos-Valadez DI, Ragupathi M, Nieto J, Patel CB, Miller S, Pickron TB, Haas EM (2012) Single incision versus conventional laparoscopic sigmoid colectomy: a case-matched series. Surg Endosc 26(1):96–102
Gaujoux S, Maggiori L, Bretagnol F, Ferron M, Panis Y (2012) Safety, feasibility, and short-term outcomes of single port access colorectal surgery: a single institutional case-matched study. J Gastrointest Surg 16:629–634
Fujii S, Watanabe K, Ota M, Watanabe J, Ichikawa Y, Yamagishi S, Tatsumi K, Suwa H, Kunisaki C, Taguri M, Morita S, Endo I (2012) 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 26:1403–1411
Kwag SJ, Kim JG, Oh ST, Kang WK (2013) Single incision vs conventional laparoscopic anterior resection for sigmoid colon cancer: a case-matched study. Am J Surg 206(3):320–325
Zhou YM, Wu LP, Zhao YF, Xu DH, Li B (2012) Single-incision versus conventional laparoscopy for colorectal disease: a meta-analysis. Dig Dis Sci 57:2103–2112
Kim CW, Cho MS, Baek SJ, Hur H, Min BS, Kang J, Baik SH, Lee KY, Kim NK (2014) Oncologic outcomes of single-incision versus conventional laparoscopic anterior resection for sigmoid colon cancer: a propensity-score matching analysis. Ann Surg Oncol. doi:10.1245/s10434-014-4039-1
Marks JH, Montenegro GA, Shields MV, Frenkel JL, Marks GJ (2014) Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: results of a 190-patient, 7-criterion case-match study. Surg Endosc 25:1887–1892
Japanese Research Society for Cancer of the Colon and Rectum (2009) Japanese Classification of Colorectal Carcinoma, 2nd English edn. Kanehara Shuppan, Tokyo
Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Takiuchi H, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J clin Oncol 17:1–29
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Ouchi M, Hirasaki Y, Azuma D (2014) Natural orifice specimen extraction using prolapsing technique in single-incision laparoscopic colorectal resections for colorectal cancers. Asian J Endosc Surg 7(1):85–88
Ishizaki T, Imanaka Y, Hirose M, Kuwabara K, Ogawa T, Harada Y (2002) A first look at variations in use of breast conserving surgery at five teaching hospitals in Japan. Int J Qual Health Care 14:411–418
Kuwabara K, Matsuda M, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K (2009) Quantitative comparison of the difficulty of performing laparoscopic colectomy at different tumor locations. World J Surg 34(1):133–139
Acknowledgments
We would like to express our sincere thanks to Dr. Manabu Yamamoto for valuable comments on this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Goutaro Katsuno, Masaki Fukunaga, Kunihiko Nagakari, Seiichiro Yoshikawa, Daisuke Azuma and Shintaro Kohama have no conflicts of interest or financial ties to disclose.
Rights and permissions
About this article
Cite this article
Katsuno, G., Fukunaga, M., Nagakari, K. et al. 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 30, 1317–1325 (2016). https://doi.org/10.1007/s00464-015-4371-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4371-y