Surgical Endoscopy

, Volume 31, Issue 6, pp 2437–2450 | Cite as

Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery

  • Ruoyan Liu
  • Yanan Wang
  • Ze Zhang
  • Tingting Li
  • Hao Liu
  • Liying Zhao
  • Haijun Deng
  • Guoxin Li



The advantages of reduced-port laparoscopic surgery (RPLS) for rectosigmoid cancer treatment have been disputed. This study evaluated the outcomes of RPLS compared to conventional laparoscopic surgery (CLS) for rectosigmoid cancer.


Data from 211 patients who underwent a selective sigmoidectomy or anterior resection from August 2011 to June 2014 at a single institution were collected and analyzed via propensity score matching. Operative outcomes, inflammatory responses, pain intensity, oncologic outcomes, quality of life, and cosmetic results were compared between groups.


After matching, 96 patients (48 CLS and 48 RPLS) were evaluated. Sixteen RPLS cases underwent single-incision laparoscopic surgery (SILS), and 32 underwent single-incision plus one port laparoscopic surgery (SILS + 1). Baseline clinical characteristics were comparable between the RPLS and the CLS groups. Morbidity, pathologic outcomes, and 3-year disease-free survival and overall survival rates were also comparable between the 2 groups. Compared with the CLS group, the RPLS group had a shorter total incision length (p < 0.001); shorter time to liquid diet (p = 0.027), ambulation (p = 0.026), and discharge (p < 0.001); and lower visual analogue scale scores during mobilization at postoperative days 3–5 (p < 0.05). The total operation times, C-reactive protein levels at 24 h and 96 h, and interleukin-6 levels at 24 h postoperatively were significantly lower in the SILS + 1 group than those in the CLS and SILS groups (p < 0.05). Compared with the CLS group, the RPLS group showed better social functioning at 6 months postoperatively (p = 0.011). The SILS and SILS + 1 groups showed similar cosmetic results, and both groups showed better results than the CLS group (p < 0.001).


RPLS for rectosigmoid cancer is feasible, with short-term safety and long-term oncological safety comparable to that of CLS. Better cosmesis and accelerated recovery can be expected. SILS + 1 is a better choice than CLS or SILS for rectosigmoid cancer because it minimizes invasiveness and reduces technical difficulties.


Single-incision laparoscopic surgery Colorectal cancer Rectosigmoid Cosmesis Inflammatory responses Propensity score 



Conventional laparoscopic surgery


Reduced-port laparoscopic surgery


Single-incision laparoscopic surgery

SILS + 1

Single-incision plus one port laparoscopic surgery


Quality of life


Body mass index


European Organization for Research and Treatment of Cancer


Patient-controlled opioid-based intravenous analgesia


Postoperative day


White blood cell


C-reactive protein




Tumor necrosis factor-α


Disease-free survival


Overall survival


Visual analogue scale



This study was supported by Major Program of Science and Technology Program of Guangzhou (No. 201300000087 and No. 201508020047), Research Fund of Public welfare in Health Industry of National Health and Family Planning Commission of China (No.201402015 and No. 201502039), National Key Technology R&D Program (No.2013BAI05B05), and Key Clinical Specialty Discipline Construction Program.

Compliance with ethical standards


Drs. Ruoyan Liu, Yanan Wang, Ze Zhang, Tingting Li, Hao Liu, Liying Zhao, Haijun Deng, and Guoxin Li have no conflicts of interest or financial ties to disclose.

Supplementary material

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Supplementary material 1 (JPEG 96 kb)
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Supplementary material 2 (JPEG 113 kb)
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Supplementary material 3 (DOCX 12 kb)
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Supplementary material 4 (DOCX 19 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ruoyan Liu
    • 1
    • 2
    • 4
    • 5
  • Yanan Wang
    • 1
  • Ze Zhang
    • 1
    • 3
    • 4
    • 5
  • Tingting Li
    • 1
  • Hao Liu
    • 1
  • Liying Zhao
    • 1
  • Haijun Deng
    • 1
  • Guoxin Li
    • 1
  1. 1.Department of General Surgery, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
  2. 2.Department of Gynecological CancerTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for CancerTianjinChina
  3. 3.Department of Head and Neck SurgeryTianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for CancerTianjinChina
  4. 4.Key Laboratory of Cancer Prevention and TherapyTianjinChina
  5. 5.Tianjin’s Clinical Research Center for CancerTianjinChina

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