Single Incision Laparoscopic Right Colectomy Could be better than the Standard Approach In Patients with Colon Cancer

Elie K Chouillard, MD, PhD, Laura Montana, MD, Vanessa Caroni, MD, Ronald Daher, MD. Paris Poissy Medical Center

Background: Natural Orifice Translumenal Endoscopic Surgery (NOTES) is an emerging surgical approach. However, human applications of “pure” NOTES techniques in are still slowed down by major technical hurdles. Concomitantly, “Hybrid” variants of NOTES and single incision laparoscopy have been increasingly reported. By further reducing the invasiveness of the standard laparoscopic approach, we may further reduce post-operative pain, decrease overall morbidity, preserve the abdominal wall, and ultimately preserve cosmesis. Such techniques have been applied to many procedures including colorectal surgery. The aim of this study is to compare the short-term results of single incision laparoscopic right colectomy (SIRC) to the standard laparoscopic right colectomy (LRC) in patients with colorectal cancer.
Methods: SIRC was attempted in 54 patients (Group A) with colon adenocarcinoma. Exclusion criteria were emergency setting (i.e., obstruction, perforation), poor general status (ASA score > 3), and a history of major abdominal surgery. Right colectomy was performed using a transumbilical incision with a special platform. The patients were retrospectively matched according to gender, body mass index (BMI), and ASA score, with 56 other patients who had LRC for adenocarcinoma during the same study period (Group B).
Results: The procedure was completed in 50 patients (92.6 %) in Group A. In 4 patients, conversion to standard laparoscopy (2 patients) or laparotomy (2 patients) occurred. In Group B, no conversion to open surgery occurred. The mean operative time was 119 minutes (range, 50-245) in the Group A and 109 minutes (range, 65-285) in the Group B, respectively (p>0.05). No mortality occurred in either group

The operative morbidity rate was 7.4 % and 11.1 %, in Group A and B, respectively (p>0.05). No hemorrhage, no surgical site infection and no fistula were encountered in either groups. The mean length of hospital stay was 4.7 days (range, 3-14) in Group A and 6.9 days (range, 4-13) In Group B, respectively (p<0.05).

Group A patients used significantly less level III pain killers as compared to patients with group B. Histological parameters of the oncological quality of the resection (margins, completeness, nodes retrieval) were similar in both groups. The average global hospitalization cost was 5898 euros per patient in Group A and 7145 euros in Group B (p<0.05).

Conclusion: SIRC for selected patients with colon adenocarcinoma was found to be sure and feasible as compared to SRC in matched patients with the same disease. It may even offer advantages including less post operative pain, shortened hospital stay, and less cost.