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Clinical impact of single-incision laparoscopic right hemicolectomy with intracorporeal resection for advanced colon cancer: propensity score matching analysis

  • Masashi Yamamoto
  • Mitsuhiro Asakuma
  • Keitaro Tanaka
  • Shinsuke Masubuchi
  • Masatsugu Ishii
  • Wataru Osumi
  • Hiroki Hamamoto
  • Junji Okuda
  • Kazuhisa UchiyamaEmail author
Article

Abstract

Background

Laparoscopic right hemicolectomy has become an acceptable treatment for right-sided colon cancer. Most centers use multiport laparoscopic right hemicolectomy extracorporeally (MRHE), whereas single-incision laparoscopic right hemicolectomy intracorporeally (SRHI) remains controversial. The aim of this study was to compare these two techniques using propensity score matching analysis.

Methods

We analyzed the data from 111 patients who underwent laparoscopic right hemicolectomy between December 2015 and December 2016. The propensity score was calculated according to age, gender, body mass index, the American Society of Anesthesiologists score, previous abdominal surgery, and D3 lymph node dissection. Postoperative pain was evaluated using a visual analogue scale (VAS) and postoperative analgesic use was an outcome measure.

Results

The length of skin incision in SRHI was significantly shorter than in MRHE [3 (3.5–6) versus 4 (3–6) cm, respectively; P = 0.007]. The VAS score on day 1 and day 2 after surgery was significantly less in SRHI than in MRHE [30 (10–50) versus 50 (20–69) on day 1, P = 0.037; 10 (0–50) versus 30 (0–70) on day 2, P = 0.029]. Significantly fewer patients required analgesia after SRHI on day 1 and day 2 after surgery [1 (0–3) versus 2 (0–4) on day 1, P = 0.024; 1 (0–2) versus 1 (0–4) on day 2, P = 0.035]. There were no significant differences in operative time, intraoperative blood loss, number of lymph nodes removed, and postoperative course between groups.

Conclusions

SRHI appears to be safe and technically feasible. Moreover, SRHI reduces the length of the skin incision and postoperative pain compared with MRHE.

Keywords

Single-incision laparoscopic surgery Intracorporeal resection Colon cancer 

Notes

Compliance with ethical standards

Disclosures

Drs. M. Yamamoto, M. Asakuma, K. Tanaka, S. Masubuchi, M. Ishii, W. Osumi, H. Hamamoto, J. Okuda, and K. Uchiyama have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Lacy AM, Gracia-Valdecasas JC, Delgango S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229CrossRefGoogle Scholar
  2. 2.
    Clinical Outcomes of Surgical Therapy Study Group (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST study group trial. Ann Surg 246:655–664CrossRefGoogle Scholar
  3. 3.
    The Colon Cancer Laparoscopic or Open Resection Study Group (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol 10:44–52CrossRefGoogle Scholar
  4. 4.
    Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the medical research council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645CrossRefGoogle Scholar
  5. 5.
    Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Sugihara K, Watanabe M, Moriya Y, Kitano S, Japan Clinical Oncology Group Colorectal Cancer Study Group (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/ III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260:23–30CrossRefGoogle Scholar
  6. 6.
    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 result of a randomized prospective study. Am J Surg 204:115–120CrossRefGoogle Scholar
  7. 7.
    Poon JTC, Cheung CW, Fan JK, Lo OS, Law WL (2012) Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc 26:2729–2734CrossRefGoogle Scholar
  8. 8.
    Watanabe J, Ota M, Fujii S, Suwa H, Ishibe A, Endo I (2016) Randomized clinical trial of single-incision versus multiport laparoscopic colectomy. Br J Surg 103:1276–1281CrossRefGoogle Scholar
  9. 9.
    Hoyuela C, Juvany M, Carvajal F (2017) Single-incision laparoscopy versus standard laparoscopy for colorectal surgery: a systematic review and meta-analysis. Am J Surg 214:127–140CrossRefGoogle Scholar
  10. 10.
    Podda M, Saba A, Porru F, Pisaynu A (2016) Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy. Surg Endosc 30:4697–4720CrossRefGoogle Scholar
  11. 11.
    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 25:1887–1892CrossRefGoogle Scholar
  12. 12.
    Keshava A, Young CJ, Richardson GL, De-Loyde K (2013) A historical comparison of single incision and conventional multiport laparoscopic right hemicolectomy. Colorectal Dis 15:e618–e622CrossRefGoogle Scholar
  13. 13.
    Feroci F, Lenzi E, Garzi A, Vannucchi A, Cantafio S, Scatizzi (2013) Intracorporeal versus extracorporeal anastomosis after laparoscopic right hemicolectomy for cancer: a systematic review and meta-analysis. Int J Colorectal Dis 28:1177–1186CrossRefGoogle Scholar
  14. 14.
    Oostendorp SV, Elfrink A, Borstlap W, Schoonmade L, Sietses C, Meijerink J, Tuynman J (2017) Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis. Surg Endosc 31:64–77CrossRefGoogle Scholar
  15. 15.
    Japanese Society for Cancer of the Colon and Rectum (2009) The guidelines for therapy of colorectal cancer. Kanehara Shuppan, TokyoGoogle Scholar
  16. 16.
    Austin PC (2009) Some methods of propensity-score matching had superior performance to others: results of an empirical investigation and Monte Carlo simulations. Biom J 51:171–184CrossRefGoogle Scholar
  17. 17.
    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 22:924–930CrossRefGoogle Scholar
  18. 18.
    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
  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 30:1317–1325CrossRefGoogle Scholar
  20. 20.
    Saltzstein SL, Behling CA (2007) Age and time as factors in the left to right shift of the subsite of colorectal adenocarcinoma: a study of 213,383 cases from the California Cancer Registry. J Clin Gastroenterol 41:173–177CrossRefGoogle Scholar
  21. 21.
    Powell AG, Wallance R, McKee RF, Anderson JH, Going JJ, Edwards J, Horgan PG (2012) The relationship between tumor site, clinicopathological characteristics and cancer-specific survival in patients undergoing surgery for colorectal cancer. Colorectal Dis 14:1493–1499CrossRefGoogle Scholar
  22. 22.
    Benedix F, Kube R, Mayer F, Schmidt U, Gastinger I, Lippert H, Colon/Rectum Carcinomas (Primary Tumor) Study Group (2010) Comparison of 17,641 patients with right- and left-sided colon cancer: differences in epidemiology, perioperative course, histology, and survival. Dis Colon Rectum 53:57–64CrossRefGoogle Scholar
  23. 23.
    Lim DR, Kuk JK, Kim T, Shin EJ (2017) Comparison of oncological outcomes of right-sided colon cancer versus left-sided colon cancer after curative resection: which side is better outcome? Medicine 96:e8241CrossRefGoogle Scholar
  24. 24.
    Leung AL, Cheung HY, Fok BK, Chung CC, Li MK, Tang CN (2013) Prospective randomized trial of hybrid NOTES colectomy versus conventional laparoscopic colectomy for left-sided colonic tumors. World J Surg 37:2678–2682CrossRefGoogle Scholar
  25. 25.
    Grams J, Tong W, Greenstein AJ, Salky B (2010) Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24:1886–1891CrossRefGoogle Scholar
  26. 26.
    Spanjersberg WR, Reuings J, Keus F, van Laarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 2:CD007635Google Scholar
  27. 27.
    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 28:1110–1118CrossRefGoogle Scholar
  28. 28.
    Agaba EA, Rainville H, Ikedilo O, Vemulapali P (2014) Incidence of port-site incisional hernia after single-incision laparoscopic surgery. JSLS 18:204–210CrossRefGoogle Scholar
  29. 29.
    Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, DeNoto G, Gecelter G, Rubach E, Rivas H, Islam A, Soper N, Paraskeva P, Rosemurgy A, Ross S, Shah S (2013) Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg 216:1037–1047CrossRefGoogle Scholar
  30. 30.
    Comajuncosas J, Hermoso J, Gris P, Jimeno J, Orbeal R, Vallverdu H, Lopez Negre JL, Urgelles J, Estalella L, Pares D (2014) Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 207:1–6CrossRefGoogle Scholar
  31. 31.
    Buckley FP 3rd, Vassaur HE, Jupiter DC, Crosby JH, Wheeless CJ, Vassaur JL (2016) Influencing factors for port-site hernias after single-incision laparoscopy. Hernia 20:729–733CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Departments of General and Gastroenterological SurgeryOsaka Medical CollegeTakatsukiJapan

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