Sang Woo Lim, Woo Sung Kang, Chang Hyun Kim, Hun Jin Kim, Jung Wook Huh, Young Jin Kim, Hyeong Rok Kim
Departments of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital
Single incision laparoscopic colectomy (SILS) has been applied for colorectal cancer as an advanced minimal invasive surgery. We evaluated the feasibility of SILS and compared the short term surgical outcomes with those of the conventional laparoscopic surgery for colorectal cancer.
Three hundred seven patients with colorectal adenocarcinoma received laparoscopic colectomy at chonnam national university Hwasun hospital between November 2011 and September 2011. Forty four patients of SILS groups were compared with 263 patients in the conventional laparoscopic surgery group. Demographic, intraoperative, and postoperative data were obtained from a prospectively single-institution laparoscopic colon cancer database and analyzed.
In SILS group, eleven (25.0%) right hemicolectomy, 15(34.1%) anterior resection, and 18(40.9%) low anterior resection were performed. Eleven patient of 18 rectal cancer were performed a diverting stoma in SILS operation, and the diverting stoma site was used as a single incision minilaparotomy in latter seven patients of them. Additional ports were required in 10 rectal patients of during SILS operation (One additional port in 7 patients and multiport conversion to conventional laparoscopic surgery in 3 patients).
Analyzing 32 patients of rectosigmoid and rectal cancer in SILS group, the patients with mid and lower rectal cancer had a tendency of a longer operation time (168.2 min vs. 223.8 min, p=0.002), additional ports or multiports conversion (p=0.007), preoperative chemoradiation (p=0.001) and subsequent diverting stoma (p<0.001) than those with rectosigmoid and upper rectal cancer.
Both SILS and conventional groups were similar in age, gender, body mass index, ASA scores, history of previous abdominal operation, and tumor location, operation type. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 min vs. 139.2 min, p<0.001). No significant differences were evident between groups for estimated blood loss, transfusion requirement, length of umbilical incisions (4.7 cm vs. 4.5 cm, p=0.728), postoperative pain score, time to 1st flatus, postoperative hospital stay, tumor size, number of harvested lymph nodes , proximal resection margins , and distal resection margins, radial margin. Postoperative morbidity was similar in both groups. There was no mortality postoperatively.
Multivariate analysis showed that tumor location of rectum (95% confidence interval [CI], 1.858-10.560;p=0.001), SILS (95% CI, 3.450-20.233; p<0.001), diverting stoma (95% CI, 1.606-9.288; p=0.003), transfusion (95% CI, 1.092-7.854; p=0.033) were independent risk factors of long operation time (> 180 min) , and that transfusion(95% CI, 1.208-6.101; p=0.016) was independently associated with postoperative morbidity.
SILS is a feasible operation for colorectal cancer and appears to have similar results to standard conventional multiport laparoscopic colectomy, although, takes more operative time. For applying SILS in rectal cancer, much more large scale prospective studies are needed.
Session: Poster Presentation
Program Number: P091