Single Incision Laparoscopic Surgery for Rectal Cancer: Early Experience with 41 Cases

Shuodong Wu, Jinyan Han. 2nd General Department

BACKGROUND: Single incision laparoscopic surgery (SILS) has evolved as an alternative method to conventional laparoscopic surgery, however, little was known about the suitability of SILS for rectal cancer resection. We performed single incision laparoscopy low anterior resection (LAR) and abdominoperineal resection (APR) from January 2010. This pilot study aimed at evaluating the feasibility, safety and oncological outcome of single incision laparoscopy LAR and APR.

METHODS: 41 selected patients underwent either single incision laparoscopic LAR or APR rectal cancer in the period between January 2010 and February 2015. All the procedures were performed with the conventional laparoscopic instruments by a single surgeon. The clinical data, surgical and oncological outcomes were retrospectively reviewed.

RESULTS: Thirty-two patients underwent single incision laparoscopic LAR, while 1 case was converted to open surgery due to adhesion, the rest were successfully accomplished (conversion rate 3.1%). Average surgery time was 179.7±59.3(115-300)min and mean estimated blood loss was 119.0±81.3(50-300)ml. Nine patients underwent single incision laparoscopic APR, while 3 cases were converted to conventional laparoscopic surgery due to adhesion or uncontrolled hemorrhage. Average surgery time was 225.6±53.7(120-320)min and mean estimated blood loss was 194.4±95.0(50-400)ml. The median number of lymph nodes harvested in the resected specimen was 14 (6-22) and all operations completely removed the tumor (R0 resection). Complications were seen in 5 patients. At a median follow-up of 35 (6-66) months, 8 (19.5%) patients developed metastatic disease. Overall, 3 patients have died.

CONCLUSION: LAR and ARP for rectal cancer can be safely performed using the SILS technique in selected patients, with acceptable surgical and oncological outcome. Further studies are necessary to better evaluate the outcome of SILS for rectal cancer.

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