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Single-incision versus conventional multiport laparoscopic surgery for colorectal cancer: a meta-analysis of randomized controlled trials and propensity-score matched studies

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Abstract

Purpose

To compare single-incision laparoscopic surgery (SILS) and multiport laparoscopic surgery (MLS) for colorectal cancer in terms of short- and long-term outcomes.

Methods

A systematic literature search was performed in PubMed, Web of Science, and Embase. Randomized controlled trials (RCTs) and propensity-score matched (PSM) studies comparing SILS and MLS for colorectal cancer were enrolled. Outcomes of interests included intraoperative, postoperative, pathological, and survival outcomes.

Results

Sixteen studies (6 RCTs and 10 PSM studies) published between 2012 and 2020 with a total of 2425 patients were enrolled. Compared with MLS, SILS was associated with less postoperative pain at postoperative day (POD) 1 (P = 0.02, MWD = −0.73, 95%CI: −1.37, −0.09) and POD2 (P < 0.001, MWD= −1.10, 95%CI: −1.45, −0.74) and shorter length of total incision length (P < 0.001, MWD = −3.31, 95%CI: −3.95, −2.67). No differences were observed in terms of operative time, blood loss, intraoperative and postoperative complications, incision hernia, and pathological or survival outcomes between SILS and MLS. Subgroup analysis for right-sided colon cancer, sigmoid colon cancer, and rectosigmoid colon cancer showed that the SILS group was only associated with less postoperative pain and shorter total incision length. The surgical and pathological outcomes were comparable between SILS and MLS.

Conclusions

SILS is a beneficial alternative to MLS in select colorectal cancer patients, especially for right-sided colon cancer, sigmoid colon cancer, and rectosigmoid cancer, with better cosmetic effects and less postoperative pain. Simultaneously, SILS does not compromise intraoperative and postoperative complications, surgical quality, or long-term outcomes.

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Funding

This work was supported by the Post-Doctor Research Project, West China Hospital, Sichuan University (2019HXBH041 to Qingbin Wu), Ministry of Science and Technology of the People’s Republic of China (2017YFC0908204 to Ziqiang Wang), and 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (2019HXFH031 to Ziqiang Wang).

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  1. Chaoyang Gu and Qingbin Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, China

    Chaoyang Gu, Qingbin Wu, Xubing Zhang, Mingtian Wei & Ziqiang Wang

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Contributions

Study concepts: Chaoyang Gu, Qingbin Wu, Ziqiang Wang.

Study design: Chaoyang Gu, Qingbin Wu, Ziqiang Wang.

Data acquisition: Qingbin Wu, Chaoyang Gu, Xubing Zhang, Mingtian Wei.

Quality control of data and algorithms: Chaoyang Gu, Qingbin Wu, Ziqiang Wang.

Data analysis and interpretation: Qingbin Wu, Chaoyang Gu.

Statistical analysis: Qingbin Wu, Chaoyang Gu.

Manuscript preparation: Qingbin Wu, Chaoyang Gu.

Manuscript editing: Chaoyang Gu, Qingbin Wu, Xubing Zhang.

Manuscript review: Chaoyang Gu, Qingbin Wu, Ziqiang Wang.

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Correspondence to Ziqiang Wang.

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Gu, C., Wu, Q., Zhang, X. et al. Single-incision versus conventional multiport laparoscopic surgery for colorectal cancer: a meta-analysis of randomized controlled trials and propensity-score matched studies. Int J Colorectal Dis 36, 1407–1419 (2021). https://doi.org/10.1007/s00384-021-03918-6

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