Feasibility of Single Site Laparoscopic Surgery for Colorectal Cancer

Ichiro Takemasa, MD PhD, Junichi Nishimura, MD PhD, Tsunekazu Mizushima, MD PhD, Masataka Ikeda, MD PhD, Hirofumi Yamamoto, MD PhD, Mitsugu Sekimoto, MD PhD, Yuichiro Doki, MD PhD, Masaki Mori, MD PhD. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University

Introduction
Single site laparoscopic surgery through the umbilicus is an emerging concept that could provide a lesser postoperative pain and offer an excellent cosmetic result. In contrast, there are some technical limitations such as instruments crowding, in-line viewing and difficulties in appropriate counter traction. The authors had reported an index case of curatively intended resection of sigmoid colon cancer with radical lymphadenectomy in this procedure. It should be careful for both safe and radical treatment to indicate for the malignant disease, however, there were few reports of its feasibility with large samples. The aim of this study is to valuate the feasibility of this procedure compared with the standard laparoscopic procedure.
Materials and Methods:
We have performed this procedure for 150 colorectal cancers since June 2009 that consist 69 right-sided colon cancers (SIR group) and 81 left-sided colon or rectal cancers (SIL group). The same cases with the standard laparoscopic procedure were adjusted in the same period. There was no difference in the patient backgrounds between two groups. Cases with clinical stage 0-II were indicated with exception for the case with lower rectal cancer, invasion to other organs or ileus. The entire laparoscopic procedures were performed using usual laparoscopic instruments through the umbilical incision. Double stapling technique was employed for the anastomosis in SIL group and extracorporeal functional end-to-end anastomosis was employed in SIR group.
Results:
The procedures were performed successfully except for the five following cases. Seven rectal cancers needed an additional port because of proper transection of the rectum and one right sided-colon cancer needed small incision of open surgery because of bleeding. There were no other intraoperative complications. Three cases with ileus and two cases with anastomotic leakage were observed postoperatively. All of these cases were recovered with conservative treatment. The median operative time and bleeding amount of SIL and SIR group were 170 min, 50 g and 180 min 30 g, respectively. The median harvested lymph nodes and length of resected specimen of SIL and SIR group were 21, 22 cm and 19, 20cm, respectively. No differences in all these results were observed between this procedure and the standard laparoscopic procedure. The scars within the umbilicus were almost invisible three months later, and almost of all patients are very satisfied with their excellent aesthetics.
Conclusion
Single site laparoscopic surgery through the umbilicus for colorectal cancer can provide excellent cosmetic results with similar safety and oncological clearance compared with usual laparoscopic procedures. This procedure is feasible and may be promising in the future.