Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery
- 350 Downloads
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.
KeywordsSingle-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
White blood cell
Tumor necrosis factor-α
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.
- 2.Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMedGoogle Scholar
- 10.Hamabe A, Takemasa I, Uemura M, Nishimura J, Mizushima T, Ikeda M, Yamamoto H, Sekimoto M, Doki Y, Mori M (2014) Feasibility of single-port laparoscopic surgery for sigmoid colon and rectal cancers and preoperative assessment of operative difficulty. J Gastrointest Surg 18:977–985CrossRefPubMedGoogle Scholar
- 11.Kawamata F, Homma S, Minagawa N, Kawamura H, Takahashi N, Taketomi A (2014) Comparison of single-incision plus one additional port laparoscopy-assisted anterior resection with conventional laparoscopy-assisted anterior resection for rectal cancer. World J Surg 38:2716–2723CrossRefPubMedGoogle Scholar
- 12.Yu H, Shin JY (2016) Short-term outcomes following reduced-port, single-port, and multi-port laparoscopic surgery for colon cancer: tailored laparoscopic approaches based on tumor size and nodal status. Int J Colorectal Dis 31:115–122Google Scholar
- 13.Edge SBBD, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
- 14.Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMedGoogle Scholar
- 15.Whistance RN, Conroy T, Chie W, Costantini A, Sezer O, Koller M, Johnson CD, Pilkington SA, Arraras J, Ben-Josef E, Pullyblank AM, Fayers P, Blazeby JM (2009) Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer 45:3017–3026CrossRefPubMedGoogle Scholar
- 17.Fayers P, Aaronson N, Bjordal K, Groenvold M, Curran D, Bottomley A (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. European Organisation for Research and Treatment of Cancer, BrusselsGoogle Scholar
- 19.Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Azuma D, Kohama S (2016) Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases. Surg Endosc 30:1317–1325Google Scholar
- 20.Hiraki M, Takemasa I, Uemura M, Haraguchi N, Nishimura J, Hata T, Mizushima T, Yamamoto H, Doki Y, Mori M (2014) Evaluation of invasiveness in single-site laparoscopic colectomy, using “the PainVision system” for quantitative analysis of pain sensation. Surg Endosc 28:3216–3223CrossRefPubMedGoogle Scholar
- 22.Bulut O, Aslak KK, Levic K, Nielsen CB, Romer E, Sorensen S, Christensen IJ, Nielsen HJ (2015) A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery. Tech Coloproctol 19:11–22CrossRefPubMedGoogle Scholar