Yasumitsu Hirano, MD, PhD1, Chikashi Hiranuma, MD, PhD2, Mari Shimada, MD2, Masakazu Hattori, MD, PhD2, Kenji Douden, MD, PhD2, Yasuo Hashizume, MD, PhD2. 1Teikyo University Mizonokuchi Hospital, 2Fukui Prefectural Hospital
Purpose: In Japan, lateral pelvic node dissection (LPND) is the standard treatment for locally advanced lower rectal cancer. There are few reports of patients undergoing single-incision plus one port laparoscopic (SILS+1) LPND even among those undergoing laparoscopic LPND. The aim of this study is to describe our initial experience and assess the feasibility and safety of SILS+1 LPND for patients with advanced lower rectal cancer.
Methods: A Lap protector (LP) was inserted through a 2.5cm transumbilical incision, and an EZ-access was mounted to LP and three 5-mm ports were placed. A 12 mm port was inserted in right lower quadrant. A single institutional experience of SILS+1 LPLND for rectal cancer are presented. Inclusion criteria was Indications for LLD were lower rectal cancer with T3–4, or T1–2 rectal cancer with metastasis of lateral lymph node, as described by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines for the treatment of colorectal cancer. Perioperative outcomes including operative time, operative blood loss, length of stay, postoperative complications, and histopathological data were collected prospectively.
Results: Between January 2014 and December 2016, 19 consecutive patients underwent SILS+1 LPND for rectal cancer. Median patient age was 67.5 years (range 43–86). Operative procedures included low anterior resections (n= 10), Hartmann procedures (n= 4) abdominoperineal resections (n= 4), and intersphincteric resection (n= 1). Bilateral lymph node dissection was performed in 16 patients. The median operative time was 429.0 (range 276-700) min, and the median blood loss was 125.8 mL (range 10-310). There were no cases of open surgery or laparoscopic conversion. The median duration of postoperative hospital stay was 14.5 days (range 8–33). No Clavien–Dindo classification Grade III–IV complications occurred, and there was no perioperative mortality. The median number of harvested lymph nodes was 28.4 (range 19-59). One patient (5.6%) developed local recurrence in this series during a median follow-up of 15 month.
Conclusions: SILS+1 LPND is a safe, feasible, and useful approach for patients with advanced lower rectal cancer. Further studies are needed prove the advantages of SILS+1 LPND or to evaluate long-term oncological outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86751
Program Number: P211
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster