Clinical impact of single-incision laparoscopic right hemicolectomy with intracorporeal resection for advanced colon cancer: propensity score matching analysis
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.
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.
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.
SRHI appears to be safe and technically feasible. Moreover, SRHI reduces the length of the skin incision and postoperative pain compared with MRHE.
KeywordsSingle-incision laparoscopic surgery Intracorporeal resection Colon cancer
Compliance with ethical standards
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.
- 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
- 15.Japanese Society for Cancer of the Colon and Rectum (2009) The guidelines for therapy of colorectal cancer. Kanehara Shuppan, TokyoGoogle Scholar
- 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
- 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
- 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