World Journal of Surgery

, Volume 38, Issue 10, pp 2716–2723 | Cite as

Comparison of Single-Incision Plus One Additional Port Laparoscopy-assisted Anterior Resection with Conventional Laparoscopy-assisted Anterior Resection for Rectal Cancer

  • Futoshi Kawamata
  • Shigenori Homma
  • Nozomi Minagawa
  • Hideki Kawamura
  • Norihiko Takahashi
  • Akinobu Taketomi



Reduced-port laparoscopic surgery is the latest innovation in minimally invasive surgery. We performed single-incision plus one additional port laparoscopy-assisted anterior resection (SILS + 1-AR) starting in August 2010. This study aimed at evaluating the feasibility of SILS + 1-AR and comparing it with that of conventional laparoscopy-assisted anterior resection (C-AR).


Patients with preoperative clinical stage 0 to stage III rectal cancer were included. Demographic, intraoperative, and pathological examination data, as well as short-term outcome data, of 20 patients who underwent SILS + 1-AR were retrospectively compared with that of 20 patients who underwent C-AR. Invasiveness of the two procedures was also evaluated through a vital signs diary and hematological examination on postoperative days (POD) 1, 3, and 7.


Operating time, mean estimated blood loss, the number of lymph nodes dissected, the number of lymph node metastases, and the mean distal resection margin length were not significantly different. However, postoperative neutrophil counts in the SILS + 1-AR group were lower than those in the C-AR group (P = 0.085). A significant difference in body temperature was observed in the SILS + 1-AR group on POD 1 (P = 0.028). No significant differences were observed in perioperative and overall morbidity between the two groups. Conversion to open surgery was required in 2 (10 %) of the 20 patients in the SILS + 1-AR group. The mean postoperative length of stay and recurrence rates were similar in the two groups.


SILS + 1-AR for rectal cancer is similar to C-AR in safety, feasibility, and provision of oncological radicality.


Rectal Cancer Total Mesorectal Excision Distal Resection Margin Blood Vessel Invasion Lymphatic Permeation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors have no conflicts of interest to declare.


  1. 1.
    Fleshman J, Sargent DJ, Green E et al (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662PubMedCrossRefGoogle Scholar
  2. 2.
    Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRefGoogle Scholar
  3. 3.
    van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218PubMedCrossRefGoogle Scholar
  4. 4.
    Ahmed K, Wang TT, Patel VM et al (2011) The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc 25:378–396PubMedCrossRefGoogle Scholar
  5. 5.
    Gandhi DP, Ragupathi M, Patel CB et al (2010) Single-incision versus hand-assisted laparoscopic colectomy: a case-matched series. J Gastrointest Surg 14:1875–1880PubMedCrossRefGoogle Scholar
  6. 6.
    Chen WT, Chang SC, Chiang HC et al (2011) Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc 25:1887–1892PubMedCrossRefGoogle Scholar
  7. 7.
    Curcillo PG (2010) Single-incision laparoscopic right hemicolectomy. Br J Surg 97:1884PubMedCrossRefGoogle Scholar
  8. 8.
    Keshava A, Young CJ, Mackenzie S (2010) Single-incision laparoscopic right hemicolectomy. Br J Surg 97:1881–1883PubMedCrossRefGoogle Scholar
  9. 9.
    Lim SW, Kim HJ, Kim CH et al (2012) Umbilical incision laparoscopic colectomy with one additional port for colorectal cancer. Tech Coloproctol 17:193–199PubMedCrossRefGoogle Scholar
  10. 10.
    Kawamura H, Tanioka T, Funakoshi T et al (2011) Dual-ports laparoscopy-assisted distal gastrectomy compared with conventional laparoscopy-assisted distal gastrectomy. Surg Laparosc Endosc Percutan Tech 21:429–433PubMedCrossRefGoogle Scholar
  11. 11.
    Hirano Y, Hattori M, Douden K et al (2012) Single-incision plus one port laparoscopic anterior resection for rectal cancer as a reduced port surgery. Scand J Surg 101:283–286PubMedCrossRefGoogle Scholar
  12. 12.
    Watanabe T, Itabashi M, Shimada Y et al (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17:1–29PubMedCrossRefGoogle Scholar
  13. 13.
    Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646PubMedCrossRefGoogle Scholar
  14. 14.
    Chambers WM, Bicsak M, Lamparelli M et al (2011) Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 13:393–398PubMedCrossRefGoogle Scholar
  15. 15.
    Osborne AJ, Lim J, Gash KJ et al (2013) Comparison of single-incision laparoscopic high anterior resection with standard laparoscopic high anterior resection. Colorectal Dis 15:329–333PubMedCrossRefGoogle Scholar
  16. 16.
    Lim SW, Kim HJ, Kim CH et al (2013) Umbilical incision laparoscopic colectomy with one additional port for colorectal cancer. Tech Coloproctol 17:193–199PubMedCrossRefGoogle Scholar
  17. 17.
    Adair J, Gromski MA, Lim RB et al (2010) Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport laparoscopic right colectomy. Dis Colon Rectum 53:1549–1554PubMedCrossRefGoogle Scholar
  18. 18.
    Egi H, Hattori M, Hinoi T et al (2012) Single-port laparoscopic colectomy versus conventional laparoscopic colectomy for colon cancer: a comparison of surgical results. World J Surg Oncol 10:61PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701PubMedCrossRefGoogle Scholar
  20. 20.
    Sauer R, Liersch T, Merkel S et al (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30:1926–1933PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Futoshi Kawamata
    • 1
  • Shigenori Homma
    • 1
  • Nozomi Minagawa
    • 1
  • Hideki Kawamura
    • 1
  • Norihiko Takahashi
    • 1
  • Akinobu Taketomi
    • 1
  1. 1.Department of Gastroenterological Surgery IHokkaido University Graduate School of MedicineSapporoJapan

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