Surgical Endoscopy

, Volume 32, Issue 3, pp 1540–1549 | Cite as

Multicenter, randomized single-port versus multiport laparoscopic surgery (SIMPLE) trial in colon cancer: an interim analysis

  • Byung Mo Kang
  • Hyung Jin Kim
  • Bong-Hyeon Kye
  • Sang Chul Lee
  • Kil Yeon Lee
  • Sun Jin Park
  • Suk-Hwan Lee
  • Sang Woo Lim
  • Yoon Suk Lee
  • Ji Hoon Kim
  • Jinkwon Lee
  • Min Ki Kim
  • Jun-Gi KimEmail author



Single-port laparoscopic surgery (SPLS) was recently introduced as an innovative minimally invasive surgery method. Retrospective studies have revealed the safety and feasibility of SPLS for colon cancer treatment. However, no prospective randomized trials have been performed. The multicenter, randomized SIMPLE (single-port versus multiport laparoscopic surgery) trial aimed to investigate short-term perioperative outcomes of SPLS for colon cancer treatment, compared with multiport laparoscopic surgery (MPLS).


Between August 2011 and April 2014, a total of 194 patients with colon cancer were recruited from seven hospitals in Korea. Patients were randomly allocated into the SPLS group (n = 99) or MPLS group (n = 95). The primary endpoint was postoperative complications. Operative, postoperative, and pathologic outcomes were analyzed after 50% of the patient study population had been recruited.


The patients’ demographic characteristics, operative times, estimated blood volume losses, numbers of harvested lymph nodes, and lengths of both resection margins were not significantly different between groups. In the SPLS group, the rates of conversion to MPLS and open surgery were 12.9 and 2.2%, respectively. Postoperative complications occurred in 10.8% of the SPLS, and 12.5% of the MPLS patients (p = 0.714). Times to functional recovery, pain scores, and amounts of analgesia were similar between groups.


The results of this interim analysis suggested that SPLS is technically safe and appropriate when used for radical resection of colon cancer. ( Identifier: NCT01480128).


Single-port Laparoscopy Colon cancer Short-term outcomes Randomized controlled trial 



This study was funded by the Korean Society of Endoscopic and Laparoscopic Surgeons’ research grant (Grant Number D2011-49).

Compliance with ethical standards


Byung Mo Kang, Hyung Jin Kim, Bong-Hyeon Kye, Sang Chul Lee, Kil Yeon Lee, Sun Jin Park, Suk-Hwan Lee, Sang Woo Lim, Yoon Suk Lee, Ji Hoon Kim, Jinkwon Lee, Min Ki Kim, and Jun-Gi Kim have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2017_5842_MOESM1_ESM.doc (217 kb)
Supplementary material 1 (DOC 217 kb)


  1. 1.
    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  2. 2.
    Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52. doi: 10.1016/S1470-2045(1008)70310-70313 Epub 72008 Dec 70313 CrossRefPubMedGoogle Scholar
  3. 3.
    Bagshaw PF, Allardyce RA, Frampton CM, Frizelle FA, Hewett PJ, McMurrick PJ, Rieger NA, Smith JS, Solomon MJ, Stevenson AR (2012) Long-term outcomes of the australasian randomized clinical trial comparing laparoscopic and conventional open surgical treatments for colon cancer: the Australasian Laparoscopic Colon Cancer Study trial. Ann Surg 256:915–919CrossRefPubMedGoogle Scholar
  4. 4.
    Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD003432.pub2 PubMedGoogle Scholar
  5. 5.
    Arezzo A, Scozzari G, Famiglietti F, Passera R, Morino M (2013) Is single-incision laparoscopic cholecystectomy safe? Results of a systematic review and meta-analysis. Surg Endosc 27:2293–2304. doi: 10.1007/s00464-00012-02763-00469 Epub 02013 Jan 00426 CrossRefPubMedGoogle Scholar
  6. 6.
    Antoniou SA, Koch OO, Antoniou GA, Lasithiotakis K, Chalkiadakis GE, Pointner R, Granderath FA (2014) Meta-analysis of randomized trials on single-incision laparoscopic versus conventional laparoscopic appendectomy. Am J Surg 207:613–622. doi: 10.1016/j.amjsurg.2013.1007.1045 Epub 2013 Nov 1019 CrossRefPubMedGoogle Scholar
  7. 7.
    Bucher P, Pugin F, Morel P (2009) Single-port access laparoscopic radical left colectomy in humans. Dis Colon Rectum 52:1797–1801. doi: 10.1007/DCR.1790b1013e3181b1551ce CrossRefPubMedGoogle Scholar
  8. 8.
    Choi SI, Lee KY, Park SJ, Lee SH (2010) Single port laparoscopic right hemicolectomy with D3 dissection for advanced colon cancer. World J Gastroenterol 16:275–278CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Huscher CG, Mingoli A, Sgarzini G, Mereu A, Binda B, Brachini G, Trombetta S (2012) Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. Am J Surg 204:115–120. doi: 10.1016/j.amjsurg.2011.1009.1005 Epub 2011 Dec 1016 CrossRefPubMedGoogle Scholar
  10. 10.
    Poon JT, Cheung CW, Fan JK, Lo OS, Law WL (2012) Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc 26:2729–2734 Epub 2012 Apr 2727 CrossRefPubMedGoogle Scholar
  11. 11.
    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 28:1110–1118. doi: 10.1007/s00464-00013-03284-x Epub 02013 Nov 00468 CrossRefPubMedGoogle Scholar
  12. 12.
    Champagne BJ, Papaconstantinou HT, Parmar SS, Nagle DA, Young-Fadok TM, Lee EC, Delaney CP (2012) Single-incision versus standard multiport laparoscopic colectomy: a multicenter, case-controlled comparison. Ann Surg 255:66–69. doi: 10.1097/SLA.1090b1013e3182378442 CrossRefPubMedGoogle Scholar
  13. 13.
    Kim NK, Kim YW, Han YD, Cho MS, Hur H, Min BS, Lee KY (2016) Complete mesocolic excision and central vascular ligation for colon cancer: principle, anatomy, surgical technique, and outcomes. Surg Oncol 25:252–262. doi: 10.1016/j.suronc.2016.1005.1009 Epub 2016 May 1020 CrossRefPubMedGoogle Scholar
  14. 14.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196. doi: 10.1097/SLA.1090b1013e3181b1013ca1092 CrossRefPubMedGoogle Scholar
  15. 15.
    Marcello PW (2011) Single incision laparoscopic colectomy: boutique surgery or the new standard? Dis Colon Rectum 54:660–661. doi: 10.1007/DCR.1000b1013e318214b318051 CrossRefPubMedGoogle Scholar
  16. 16.
    Ramos-Valadez DI, Ragupathi M, Nieto J, Patel CB, Miller S, Pickron TB, Haas EM (2012) Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series. Surg Endosc 26:96–102. doi: 10.1007/s00464-00011-01833-00468 Epub 02011 Jul 00427 CrossRefPubMedGoogle Scholar
  17. 17.
    Papaconstantinou HT, Thomas JS (2011) Single-incision laparoscopic colectomy for cancer: assessment of oncologic resection and short-term outcomes in a case-matched comparison with standard laparoscopy. Surgery 150:820–827. doi: 10.1016/j.surg.2011.1007.1060 CrossRefPubMedGoogle Scholar
  18. 18.
    Chen WT, Chang SC, Chiang HC, Lo WY, Jeng LB, Wu C, Ke TW (2011) Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc 25:1887–1892. doi: 10.1007/s00464-00010-01481-00464 Epub 02011 Feb 00427 CrossRefPubMedGoogle Scholar
  19. 19.
    Kwag SJ, Kim JG, Oh ST, Kang WK (2013) Single incision vs conventional laparoscopic anterior resection for sigmoid colon cancer: a case-matched study. Am J Surg 206:320–325. doi: 10.1016/j.amjsurg.2012.1011.1007 Epub 2013 Apr 1016 CrossRefPubMedGoogle Scholar
  20. 20.
    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 22:924–930. doi: 10.1245/s10434-10014-14039-10431 Epub 12014 Sep 10439 CrossRefPubMedGoogle Scholar
  21. 21.
    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 263:973–978. doi: 10.1097/SLA.0000000000001226 CrossRefPubMedGoogle Scholar
  22. 22.
    Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP (2011) Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum 54:183–186. doi: 10.1007/DCR.1000b1013e3181fd1048af CrossRefPubMedGoogle Scholar
  23. 23.
    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 254:933–940. doi: 10.1097/SLA.1090b1013e318237826b CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Byung Mo Kang
    • 1
  • Hyung Jin Kim
    • 2
  • Bong-Hyeon Kye
    • 2
  • Sang Chul Lee
    • 3
  • Kil Yeon Lee
    • 4
  • Sun Jin Park
    • 4
  • Suk-Hwan Lee
    • 5
  • Sang Woo Lim
    • 6
  • Yoon Suk Lee
    • 7
  • Ji Hoon Kim
    • 7
  • Jinkwon Lee
    • 8
    • 9
  • Min Ki Kim
    • 8
  • Jun-Gi Kim
    • 8
    Email author
  1. 1.Department of Surgery, Chuncheon Sacred Heart HospitalHallym University College of MedicineChuncheonKorea
  2. 2.Department of Surgery, St. Vincent’s Hospital, College of MedicineThe Catholic University of KoreaSuwonKorea
  3. 3.Department of Surgery, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaDaejeonKorea
  4. 4.Department of Surgery, Kyung Hee Medical CenterKyung Hee University School of MedicineSeoulKorea
  5. 5.Department of Surgery, Kyung Hee University Hospital at GangdongKyung Hee University School of MedicineSeoulKorea
  6. 6.Department of Surgery, Hallym Sacred Heart HospitalHallym University College of MedicineAnyangKorea
  7. 7.Department of Surgery, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaIncheonKorea
  8. 8.Department of Surgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulKorea
  9. 9.Department of Surgery, Changwon Gyeongsang National University HospitalGyeongsang National UniversityChangwonKorea

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