Long-term outcomes of Single Incision Laparoscopic Colorectal resection (SILC) in our consecutive 272 colorectal cancer patients

Goutaro Katsuno, MD, PhD, Masaki Fukunaga, MD, PhD, Tetsu Fukunaga, MD, PhD, Kunihiko Nagakari, MD, PhD, Kunihiro Yamasawa, MD, PhD, Seiichirou Yoshikawa, MD, PhD, Masaru Suda, MD, PhD, Yoshito Iida, MD, PhD, Masakazu Ohuchi, MD, PhD, Satoshi Kanda, MD, PhD, Yoshinori Hirasaki, MD, PhD, Mayuko Itou, MD, PhD, Yukinori Yube, MD, Daisuke Azuma, MD, Shintaro Kohama, MD, Jun Nomoto, MD. Department of Surgery, Juntendo Urayasu Hospital, Juntendo University

Introduction/ Design: We report here the long-term outcomes of the consecutive 272 patients treated with single-incision laparoscopic colorectal resection (SILC) for colorectal cancer between April 2009 and September 2015.

Technique: SILC was performed using a surgical technique similar to the conventional laparoscopic medial-to-lateral approach.  When it was technically difficult to cut the lower rectum, we often used “plus one port” or “NOSE (Natural Orifice Specimen Extraction) with prolapsing technique” to cut the rectum more confidently.

Results: We reported 272 SILC patients with colon (83.5 %) and rectal cancer (16.5 %). Of them, tumor was located at cecum in 64, ascending colon in 44, transverse colon in 23, descending colon in 11, sigmoid colon in 85, upper rectum in 39 and lower rectum in 6 patients. TNM stage was 0-I in 146, IIA in 49, IIB in 3, IIC in 2, IIIA in 14, IIIB in 42, IIIC in 10 and IV in 6 patients. T stage was T0-1 in 120, T2 in 36, T3 in 99, T4 in 17, respectively. There were 135 men (49.6%) and 137 women (50.4%) in this study; the mean age was 65.4 years and the mean BMI was 22.8.  We tended to perform SILC for relatively early stage colorectal cancer in right-sided colon, sigmoid colon or upper rectum. The mean operating time was 152 ± 45 min. The mean bleeding volume was 23 ± 10 ml. One patient (0.37%) was converted to the multi-port method due to severe adhesion. In 45 rectal cancer cases, NOSE with prolapsing technique was used in 20 rectal cancer patients, and +1 port technique in 18 patients. In total, +1 port technique was used in 28 cases (10.3%). Postoperatively, there was no mortality and no major postoperative complications such as anastmotic leakage. Postoperative morbidity rates were 3.3 %. The number of harvested lymph nodes was 25±6. The mean tumor-free resection margin was 11.7 ± 4.4 cm. The mean follow-up periods were 40±19 months. The 5-year overall survival rates in stage 0-III were 95.4%, 100% in Stage I, 100% in Stage II, 90% in Stage III, and the 5-year disease-free survival rates in stage 0-III were 94.6%, 100% in Stage I, 100% in Stage II, 83.3% in Stage III, respectively.

Conclusion: SILC for colorectal cancer may be a technically and oncologically safe option in strictly selected patients, e.g. low BMI (<30), relatively low T stage (<T4) and relatively early stage cancer.

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