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

Goutaro Katsuno, Masaki Fukunaga, Yoshifumi Lee, Kunihiko Nagakari, Masahiko Sugano, Shuichi Sakamoto, Yoshito Iida, Seiichiro Yoshikawa, Masakazu Ohuchi, Yoshitomo Itou, Yoshinori Hirasaki, Daisuke Azuma, Shintaro Kohama, Jun Nomoto. Department of Surgery, Juntendo Urayasu Hospital, Juntendo University

[INTRODUCTION]: Recently, feasibility and safety of single-incision laparoscopic colorectal resection (SILC) for colorectal cancer has been reported; however, benefits and outcomes are not well defined. The aim of this study was to reveal short-term and long-term outcomes of SILC compared with multi-incision laparoscopic colorectal resection (MILC) for colorectal cancer using propensity score matching analysis.

[EXCLUSION CRITERIA FOR SILC]:(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 (5) obese patients: BMI>30

[STUDY DESIGN/METHOD]: The study group included 235 patients who underwent SILC and 730 patients who underwent MILC for colorectal cancer between Apr 2009 and Sep 2014. Data on short- and long-term outcomes were collected prospectively and reviewed. 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 outcomes of the patients in the two groups were then compared.

[PROCEDURE]: A single intraumbilical 25-30 mm incision is made, and the umbilicus is pulled out. The access platform is placed in the small umbilical incision area. Recently, we often use EZ accessTM as a Multi-access platform. Then, SILC is performed using a surgical technique similar to the conventional laparoscopic medial-to-lateral approach by standard straight laparoscopic instruments. The bowel is transected either intracorporeally or extracorporeally with lymph node dissection, and then a stapled anastomosis is performed

[RESULTS]: No significant differences were observed in the mean length of the operation (158 vs. 165 min), blood loss (20 vs. 24 ml), time to liquid diet (1.5 vs. 1.3 days) and length of hospital stay (10 vs. 11 days) between the SILC and MILC groups. However, the SILC group showed less analgesic requirements (1.1 vs. 1.9 times; p = 0.000) and shorter length of incision (2.7 vs. 4.3 cm; p = 0.000) compared to the MILC group. The overall rate of postoperative complications was similar in both groups (2.8% versus 3.7%, NS). There was no mortality in both groups. The number of harvested lymph nodes was comparable between the two groups (16.7 versus 15.5, NS).

The 5-year overall survival rates of the SILC and MILC groups were 100 and 95 % (p = 0.125), and the 5-year disease-free survival rates in stage 0-III were 97 and 94 % (p = 0.189), 100 and 92% in Stage II, 90 and 85% in Stage III, respectively.

[CONCLUSIONS]: This propensity score matching case-control study of 214 patients suggests that SILC for colorectal cancer is a safe and feasible option with better cosmetic results in strictly selected patients. SILC can also produce good oncological results with similar postoperative outcomes of to MILC.

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