Evaluation for Less Invasiveness in Single Port Laparoscopic Surgery for Colorectal Cancer

Masayuki Hiraki, MD, Ichiro Takemasa, MD, PhD, Mamoru Uemura, MD, PhD, Naotsugu Haraguchi, MD, PhD, Junichi Nishimura, MD, PhD, Taishi Hata, MD, PhD, Tsunekazu Mizushima, MD, PhD, Hirohumi Yamamoto, MD, PhD, Yuichiro Doki, MD, PhD, Masaki Mori, MD, PhD

Osaka University, Graduate School of Medicine, Department of Gastroenterological Surgery

INTRODUCTION
There is significant interest in further reducing the trauma associated with surgical procedures. In late years single port laparoscopic surgery (SPLS) is rapidly spreading by the improved cosmesis and less invasiveness. SPLS came to be gradually performed for colorectal cancer, and it has been reported that SPLS is both safe and feasible in colorectal cancer, and that it has equivalent or better short-term outcomes than conventional laparoscopic surgery (CLS). However, few comparative studies for SPLS and CLS have been reported on less invasiveness including postoperative pain in colorectal cancer.

METHODS AND PROCEDURES
We retrospectively compared SPLS group (n=11) with CLS group (n=11) for postoperative pain to evaluate less invasiveness of SPLS for colorectal cancer. Patients were specifically matched in regard to patient’s age, gender, BMI, tumor location, and tumor size. Postoperative pain was evaluated using a visual analogue scale (VAS) and postoperative frequency of analgesics as primary outcome measures. Both VAS at rest and on exercise were measured each on 1, 2, 3, 4, 7th day after surgery. Secondary outcome measures were time duration before first flatus, blood test results (C-reactive protein and WBC ) on the day after surgery, and postoperative early complications .

RESULTS
Both VAS at rest and on exercise on day 1 after surgery were significantly less in the SPLS group than in the CLS group (11.8±8.7 vs. 28.2±11.7;P=0.0023, 36.4±23.8 vs. 56.4±17.5;P=0.0183). In addition, both sequential VAS at rest and on exercise until the 7th day after surgery were also significantly less in the SPLS group than in the CLS group (P=0.0064, P=0.0119;two-way ANOVA). However, frequency of narcotic analgesics (2.7±2.2 vs. 3.6±3.4;P=0.7394) and frequency of total analgesics (5.5±5.0 vs. 10.6±7.2;P=0.0801) were comparable. There were no significant differences in time duration before first flatus (2±0.89 vs. 1.3±0.9;P=0.0541), C-reactive protein (5.0±3.5 vs. 6.7±4.6;P=0.4905), WBC (8406±2821 vs. 8672±4176;P=0.7675) on the day after surgery, and postoperative early complications.

CONCLUSION
In a subjective evaluation using VAS, SPLS for colorectal cancer significantly reduces postoperative pain compared with CLS. SPLS requires further prospective validation in the future to confirm it scientifically.

Session: Poster Presentation

Program Number: P503