Goutaro Katsuno, MD PhD, Masaki Fukunaga, MD PhD, Hidenori Tsumura, MD PhD, Masahiko Sugano, MD PhD, Yoshifumi Lee, MD PhD, Kunihiko Nagakari, MD PhD, Shuichi Sakamoto, MD PhD, Masaru Suda, MD PhD, Yoshito Iida, MD PhD, Seiichiro Yoshikawa, MD PhD,. Department of Surgery, Juntendo Urayasu Hospital, Juntendo University,
Background: Transumbilical single port surgery (SPS) has been developed with the aim of further reducing the invasiveness of conventional laparoscopic surgery because of the inconvenience associated with natural orifice transluminal endoscopic surgery (NOTES). We conducted a retrospective matched case-control study to compare the short-term outcomes of Single Incision Laparoscopic Colectomy (SILC) and conventional laparoscopic colectomy (LAC) for colon cancer.
Indications for SILC: The indications for SILC were as follows: (1) tumors located at the cecum, ascending colon, sigmoid colon, or upper rectum; (2) relatively small tumor (less than 4cm); (3) cSE(-); (4) cN0 or cN1; (5) cP(-); and (6) thick bulky mesorectum/mesocolon(-) (BMI <25).
The 50 patients who underwent SILC were matched with 50 patients undergoing LAC from a database of 1500 patients. The two groups were matched in terms of BMI, age, gender, type of resection, and indication criteria for SILC. The outcomes of the patients in the two groups were then compared
Procedures: A single intraumbilical 25-30 mm incision was made, and the umbilicus was pulled out, exposing the fascia with moderate subcutaneous exfoliation. Three 5-mm ports or a multi-instrument access port were placed at the umbilical site. The umbilicus was the access point of entry to the abdomen for all patients. SILC was performed using a surgical technique similar to the standard laparoscopic medial-to-lateral approach. The bowel was transected either intracorporeally or extracorporeally with lymph node dissection, and then a stapled anastomosis was performed
Results: Mean operating times were comparable between SILC and LAC groups (146.3 ± 39.2 min versus 158.7 ± 49.8 min, not significant (NS)). Mean bleeding volumes were comparable between the two groups (29.1 ± 21 ml versus 30.7 ± 23 ml, NS). One patient (2%) required conversion to LAC due to dense adhesions. Postoperatively, there was no mortality in either group. In terms of analgesic use, there was no difference between the two groups (1.0 ± 1.3 times versus 1.1 ± 0.8 times, NS). The mean hospital stay was 9.7 ± 1.7 days in the SILC group and 9.8 ± 2.6 days in the LAC group (NS). The overall rate of postoperative complications was similar in both groups (6.0% versus 8.0%, NS). The wound was infected in 4% of patients in each group. There was no small bowel obstruction in either group. Other postoperative complications included hematochezia in one patient in the SILC group, and enteritis in two patients in the LAC group. The number of harvested lymph nodes was comparable between the two groups (18.3 ± 4 versus 17.9 ± 4, NS)
Conclusion: This matched case–control study suggested that SILC for colon cancer is feasible and safe in selected patients and can result in good surgical results, with similar postoperative outcomes to LAC.
Program Number: P112