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Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery

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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.

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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

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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.

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    Authors and Affiliations

    1. Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China

      Ruoyan Liu, Yanan Wang, Ze Zhang, Tingting Li, Hao Liu, Liying Zhao, Haijun Deng & Guoxin Li

    2. Department of Gynecological Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China

      Ruoyan Liu

    3. Department of Head and Neck Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China

      Ze Zhang

    4. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China

      Ruoyan Liu & Ze Zhang

    5. Tianjin’s Clinical Research Center for Cancer, Tianjin, China

      Ruoyan Liu & Ze Zhang

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    1. Ruoyan Liu
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    Correspondence to Haijun Deng or Guoxin Li.

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    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.

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    Ruoyan Liu and Yanan Wang have contributed equally to this work and should be considered co-first authors.

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    Liu, R., Wang, Y., Zhang, Z. et al. Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery. Surg Endosc 31, 2437–2450 (2017). https://doi.org/10.1007/s00464-016-5244-8

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    • DOI: https://doi.org/10.1007/s00464-016-5244-8

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