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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
Article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Keywords

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

Abbreviations

CLS

Conventional laparoscopic surgery

RPLS

Reduced-port laparoscopic surgery

SILS

Single-incision laparoscopic surgery

SILS + 1

Single-incision plus one port laparoscopic surgery

QOL

Quality of life

BMI

Body mass index

EORTC

European Organization for Research and Treatment of Cancer

PCIA

Patient-controlled opioid-based intravenous analgesia

POD

Postoperative day

WBC

White blood cell

CRP

C-reactive protein

IL-6

Interleukin-6

TNF-α

Tumor necrosis factor-α

DFS

Disease-free survival

OS

Overall survival

VAS

Visual analogue scale

Notes

Acknowledgments

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

Disclosure

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 4 (DOCX 19 kb)

References

  1. 1.
    Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRefPubMedGoogle Scholar
  2. 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
  3. 3.
    Curcillo PG 2nd, Podolsky ER, King SA (2011) The road to reduced port surgery: from single big incisions to single small incisions, and beyond. World J Surg 35:1526–1531CrossRefPubMedGoogle Scholar
  4. 4.
    Takemasa I, Uemura M, Nishimura J, Mizushima T, Yamamoto H, Ikeda M, Sekimoto M, Doki Y, Mori M (2014) Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer: a prospective case-control comparison. Surg Endosc 28:1110–1118CrossRefPubMedGoogle Scholar
  5. 5.
    Kim SJ, Ryu GO, Choi BJ, Kim JG, Lee KJ, Lee SC, Oh ST (2011) The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg 254:933–940CrossRefPubMedGoogle Scholar
  6. 6.
    Kim CW, Cho MS, Baek SJ, Hur H, Min BS, Kang J, Baik SH, Lee KY, Kim NK (2015) Oncologic outcomes of single-incision versus conventional laparoscopic anterior resection for sigmoid colon cancer: a propensity-score matching analysis. Ann Surg Oncol 22:924–930CrossRefPubMedGoogle Scholar
  7. 7.
    Yun JA, Yun SH, Park YA, Huh JW, Cho YB, Kim HC, Lee WY (2016) Oncologic outcomes of single-incision laparoscopic surgery compared with conventional laparoscopy for colon cancer. Ann Surg. 263:973–978CrossRefGoogle Scholar
  8. 8.
    Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR (2013) Umbilical incision laparoscopic colectomy with one additional port for colorectal cancer. Tech Coloproctol 17:193–199CrossRefPubMedGoogle Scholar
  9. 9.
    Gash K, Bicsak M, Dixon A (2015) Single incision laparoscopic surgery for rectal cancer: early results and medium term oncological outcome. Colorectal Dis 17:1071–1078CrossRefPubMedGoogle Scholar
  10. 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. 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. 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. 13.
    Edge SBBD, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  14. 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. 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
  16. 16.
    Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA (1998) Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc 12:1334–1340CrossRefPubMedGoogle Scholar
  17. 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
  18. 18.
    Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016CrossRefPubMedGoogle Scholar
  19. 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. 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
  21. 21.
    Moraca RJ, Sheldon DG, Thirlby RC (2003) The role of epidural anesthesia and analgesia in surgical practice. Ann Surg 238:663–673CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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
  23. 23.
    Jung IK, Kim MC, Kim KH, Kwak JY, Jung GJ, Kim HH (2008) Cellular and peritoneal immune response after radical laparoscopy-assisted and open gastrectomy for gastric cancer. J Surg Oncol 98:54–59CrossRefPubMedGoogle Scholar
  24. 24.
    Nelson H, Petrelli N, Carlin A, Couture J, Fleshman J, Guillem J, Miedema B, Ota D, Sargent D (2001) Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst 93:583–596CrossRefPubMedGoogle Scholar

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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