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Long-term outcomes of single-incision versus multiport laparoscopic colectomy for colon cancer: results of a propensity score-based analysis

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Abstract

Background

Long-term outcomes of single-incision laparoscopic colectomy (SILC) for colon cancer (CC), as practiced in real-world settings, especially in relation to disease stage, have not been established. We examined, retrospectively, both short- and long-term outcomes of SILC versus those of multiport laparoscopic colectomy (MPLC) performed for CC in a propensity-score-matched cohort.

Methods

The study involved 263 patient pairs matched 1:1 from among 691 patients who, between January 2008 and May 2014, underwent either SILC or MPLC for a primary solitary CC at our hospital. Short-term and long-term operative outcomes were compared between the two groups.

Results

Operation time was the only surgical outcome that varied significantly between the two groups (p = 0.0004). Overall 5-year cancer-specific survival (CSS) in the SILC group was 93.7 (95% CI 89.6–96.2)%, and CSS per pathological stage (I, II and III) was 98.5 (90.0–99.8)%, 96.0 (88.2–98.7)%, and 88.3 (79.6–93.6)%, respectively, whereas overall 5-year CSS in the MPLC group was 93.3 (89.4–95.9)%, and CSS per pathological stage was 100%, 95.4 (88.3–98.3)%, and 84.1 (74.1–90.8)% (p = 0.5278, 0.2679, 0.7666, and 0.9073), respectively. Overall 3-year disease-free survival (DFS) in the SILC group was 94.0 (90.2–96.4)%, and 3-year DFS per pathological stage was 98.6 (90.4–99.8)%, 90.1 (81.4–95.0)%, and 79.0 (69.4–86.2)%, respectively, whereas overall 3-year DFS in the MPLC group was 93.2 (89.4–95.7)%, and 3-year DFS per pathological disease stage was 100%, 94.5 (87.4–97.7)% and 75.5 (64.7–83.8)% (p = 0.2829, 0.7401, 0.4335 and 0.8518), respectively. Thus, oncological outcomes did not differ significantly between groups. Incisional hernia occurred in 21 (8.0%) SILC group patients and 17 (6.5%) MPLC group patients, without a significant between-group difference (p = 0.6139).

Conclusion

Our data indicate that perioperative and oncological outcomes of SILC performed for CC are comparable to those of MPLC performed for CC.

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References

  1. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    PubMed  Google Scholar 

  2. Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Ota D (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

    CAS  PubMed  Google Scholar 

  3. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW, Jr., Hellinger M, Flanagan R, Jr., Peters W, Nelson H (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surgery 246:655–662; discussion 662–654

  4. Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Påhlman 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

    PubMed  Google Scholar 

  5. Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, Smith JS, Solomon MJ, Stephens JH, Stevenson AR (2008) Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg 248:728–738

    PubMed  Google Scholar 

  6. Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, Sugihara K, Watanabe M, Moriya Y, Kitano S (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 260:23–30

    PubMed  Google Scholar 

  7. Haueter R, Schutz T, Raptis DA, Clavien PA, Zuber M (2017) Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg 104:1141–1159

    CAS  PubMed  Google Scholar 

  8. Lo CW, Yang SS, Tsai YC, Hsieh CH, Chang SJ (2016) Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis. Hernia 20:21–32

    PubMed  Google Scholar 

  9. Xu AM, Huang L, Li TJ (2015) Single-incision versus three-port laparoscopic appendectomy for acute appendicitis: systematic review and meta-analysis of randomized controlled trials. Surg Endosc 29:822–843

    PubMed  Google Scholar 

  10. Makino T, Milsom JW, Lee SW (2012) Feasibility and safety of single-incision laparoscopic colectomy: a systematic review. Ann Surg 255:667–676

    PubMed  Google Scholar 

  11. Podda M, Saba A, Porru F, Pisanu A (2016) Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy. Surg Endosc 30:4697–4720

    PubMed  Google Scholar 

  12. Yang TX, Chua TC (2013) Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. Int J Colorectal Dis 28:89–101

    PubMed  Google Scholar 

  13. Luján JA, Soriano MT, Abrisqueta J, Pérez D, Parrilla P (2015) Single-port colectomy VS multi-port laparoscopic colectomy. systematic review and meta-analysis of more than 2800 procedures. Cir Esp 93:307–319

    PubMed  Google Scholar 

  14. 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 214:127–140

    PubMed  Google Scholar 

  15. Maggiori L, Tuech JJ, Cotte E, Lelong B, Denost Q, Karoui M, Vicaut E, Panis Y (2018) Single-incision laparoscopy versus multiport laparoscopy for colonic surgery: a multicenter, double-blinded, randomized controlled trial. Ann Surg 268:740–746

    PubMed  Google Scholar 

  16. Kang BM, Kim HJ, Kye BH, Lee SC, Lee KY, Park SJ, Lee SH, Lim SW, Lee YS, Kim JH, Lee J, Kim MK, Kim JG (2018) Multicenter, randomized single-port versus multiport laparoscopic surgery (SIMPLE) trial in colon cancer: an interim analysis. Surg Endosc 32:1540–1549

    PubMed  Google Scholar 

  17. 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 103:1276–1281

    CAS  PubMed  Google Scholar 

  18. 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 28:3216–3223

    PubMed  Google Scholar 

  19. team TACSmaec (2020) Survival Rates for Colorectal Cancer.

  20. (2005) 2005 Update of ASCO Practice Guideline Recommendations for Colorectal Cancer Surveillance: Guideline Summary. J Oncol Pract 1:137–139

  21. Tei M, Otsuka M, Suzuki Y, Akamatsu H (2018) Initial experience of single-port laparoscopic multivisceral resection for locally advanced colon cancer. Surg Laparosc Endosc Percutan Tech 28:108–112

    PubMed  Google Scholar 

  22. Tei M, Otsuka M, Suzuki Y, Kishi K, Tanemura M, Akamatsu H (2018) Safety and feasibility of single-port surgery for colon cancer in octogenarians. Anticancer Res 38:2967–2972

    PubMed  Google Scholar 

  23. Tei M, Otsuka M, Suzuki Y, Kishi K, Tanemura M, Akamatsu H (2018) Clinical outcomes of single-port surgery for colon cancer in octogenarians. Surg Laparosc Endosc Percutan Tech 28:164–169

    PubMed  Google Scholar 

  24. Tei M, Otsuka M, Suzuki Y, Kishi K, Tanemura M, Akamatsu H (2018) Safety and feasibility of single-port laparoscopic low anterior resection for upper rectal cancer. Am J Surg 216:1101–1106

    PubMed  Google Scholar 

  25. Tei M, Wakasugi M, Omori T, Ueshima S, Tori M, Akamatsu H (2015) Single-port laparoscopic colectomy is safe and feasible in patients with previous abdominal surgery. Am J Surg 209:1007–1012

    PubMed  Google Scholar 

  26. Suzuki Y, Tei M, Wakasugi M, Masuzawa T, Ohtsuka M, Mikamori M, Saito T, Furukawa K, Imasato M, Kishi K, Tanemura M, Akamatsu H (2020) Role of single-incision laparoscopic surgery in the management of small bowel obstruction. Surg Endosc. https://doi.org/10.1007/s00464-020-07671-9

    Article  PubMed  Google Scholar 

  27. James D. Brierley MKG, Christian Wittekind (2016) TNM Classification of Malignant Tumours, 8 edn, John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

  28. Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, Hamaguchi T, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kawano H, Kinugasa Y, Kokudo N, Murofushi K, Nakajima T, Oka S, Sakai Y, Tsuji A, Uehara K, Ueno H, Yamazaki K, Yoshida M, Yoshino T, Boku N, Fujimori T, Itabashi M, Koinuma N, Morita T, Nishimura G, Sakata Y, Shimada Y, Takahashi K, Tanaka S, Tsuruta O, Yamaguchi T, Yamaguchi N, Tanaka T, Kotake K, Sugihara K (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol 23:1–34

    PubMed  Google Scholar 

  29. Zaheer S, Pemberton JH, Farouk R, Dozois RR, Wolff BG, Ilstrup D (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227:800–811

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis 11:354–364; discussion 364–355

  31. West NP, Kobayashi H, Takahashi K, Perrakis A, Weber K, Hohenberger W, Sugihara K, Quirke P (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30:1763–1769

    PubMed  Google Scholar 

  32. Rectum JSfCotCa (2019) Japanese classification of colorectal, appendiceal, and anal carcinoma: the 3d English Edition [Secondary Publication]. J Anus Rectum Colon 3:175–195

  33. Boyne DJ, Cuthbert CA, O’Sullivan DE, Sajobi TT, Hilsden RJ, Friedenreich CM, Cheung WY, Brenner DR (2019) Association between adjuvant chemotherapy duration and survival among patients with stage II and III colon cancer: a systematic review and meta-analysis. JAMA Netw Open 2:e194154

    PubMed  PubMed Central  Google Scholar 

  34. Kim CW, Hur H, Min BS, Baik SH, Lee KY, Kim NK (2017) Oncologic outcomes of single-incision laparoscopic surgery for right colon cancer: a propensity score-matching analysis. Int J Surg 45:125–130

    PubMed  Google Scholar 

  35. Song Z, Li Y, Liu K, Jiang Y, Shi Y, Ji X, Zhang T, Wu H, Shi Y, Zhao R (2019) Clinical and oncologic outcomes of single-incision laparoscopic surgery for right colon cancer: a propensity score matching analysis. Surg Endosc 33:1117–1123

    PubMed  Google Scholar 

  36. 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

    PubMed  Google Scholar 

  37. Miyo M, Takemasa I, Ishihara H, Hata T, Mizushima T, Ohno Y, Doki Y, Mori M (2017) Long-term outcomes of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer: comparison with conventional multiport laparoscopic colectomy using propensity score matching. Dis Colon Rectum 60:664–673

    PubMed  Google Scholar 

  38. 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 30:1317–1325

    PubMed  Google Scholar 

  39. Hirano Y, Hiranuma C, Hattori M, Douden K, Yamaguchi S (2019) Long-term oncological outcomes of single-port laparoscopic surgery for colon cancer. ANZ J Surg 89:408–411

    PubMed  Google Scholar 

  40. Schmoll HJ, Twelves C, Sun W, O’Connell MJ, Cartwright T, McKenna E, Saif M, Lee S, Yothers G, Haller D (2014) Effect of adjuvant capecitabine or fluorouracil, with or without oxaliplatin, on survival outcomes in stage III colon cancer and the effect of oxaliplatin on post-relapse survival: a pooled analysis of individual patient data from four randomised controlled trials. Lancet Oncol 15:1481–1492

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Nagata H, Kawai K, Hata K, Tanaka T, Nozawa H, Ishihara S (2020) Laparoscopic surgery for T4 colon cancer: a risk factor for peritoneal recurrences? Surgery 168:119–124

    PubMed  Google Scholar 

  42. Hasegawa H, Okabayashi K, Watanabe M, Ashrafian H, Harling L, Ishii Y, Sugiyama D, Seishima R, Darzi A, Athanasiou T, Kitagawa Y (2014) What is the effect of laparoscopic colectomy on pattern of colon cancer recurrence? A propensity score and competing risk analysis compared with open colectomy. Ann Surg Oncol 21:2627–2635

    PubMed  Google Scholar 

  43. 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

    PubMed  Google Scholar 

  44. 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 18:977–985

    PubMed  Google Scholar 

  45. Antoniou SA, Garcia-Alamino JM, Hajibandeh S, Weitzendorfer M, Muysoms FE, Granderath FA, Chalkiadakis GE, Emmanuel K, Antoniou GA, Gioumidou M, Iliopoulou-Kosmadaki S, Mathioudaki M, Souliotis K (2018) Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION). Surg Endosc 32:14–23

    PubMed  Google Scholar 

  46. Connell MB, Selvam R, Patel SV (2019) Incidence of incisional hernias following single-incision versus traditional laparoscopic surgery: a meta-analysis. Hernia 23:91–100

    CAS  PubMed  Google Scholar 

  47. 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 20:729–733

    PubMed  Google Scholar 

  48. Watanabe J, Ishibe A, Suwa Y, Suwa H, Ota M, Kubota K, Yamanaka T, Kunisaki C, Endo I (2020) Hernia incidence following a randomized clinical trial of single-incision versus multi-port laparoscopic colectomy. Surg Endosc

  49. Benlice C, Stocchi L, Costedio MM, Gorgun E, Kessler H (2016) Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection. Dis Colon Rectum 59:743–750

    PubMed  Google Scholar 

  50. Arnold M, Rutherford MJ, Bardot A, Ferlay J, Andersson TM, Myklebust T, Tervonen H, Thursfield V, Ransom D, Shack L, Woods RR, Turner D, Leonfellner S, Ryan S, Saint-Jacques N, De P, McClure C, Ramanakumar AV, Stuart-Panko H, Engholm G, Walsh PM, Jackson C, Vernon S, Morgan E, Gavin A, Morrison DS, Huws DW, Porter G, Butler J, Bryant H, Currow DC, Hiom S, Parkin DM, Sasieni P, Lambert PC, Møller B, Soerjomataram I, Bray F (2019) Progress in cancer survival, mortality, and incidence in seven high-income countries 1995–2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol 20:1493–1505

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors thank Dr. Michitaka Honda of Fukushima Medical University for his advice on statistical issues and Prof. Tina Tajima of St. Marianna University School of Medicine for her meticulous English editing.

Funding

The work described herein was supported by departmental resources only.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan

    Yozo Suzuki, Yujiro Nakahara, Atsushi Naito, Manabu Mikamori, Kenta Furukawa, Masahisa Ohtsuka, Jeong Ho Moon, Mitsunobu Imasato, Tadafumi Asaoka, Kentaro Kishi & Hiroki Akamatsu

  2. Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan

    Yozo Suzuki

  3. Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan

    Mitsuyoshi Tei & Masaki Wakasugi

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  1. Yozo Suzuki
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Contributions

YS and MT conceived and designed the study, YS, MT, MW, MO, and HA acquired data, YS, MT, and HA analyzed and interpreted the data, YS drafted the manuscript, MT, MW, YN, AN, MM, KF, MO, JM, MI, TA, KK, and HA critically revised the article and MT, MW, YN, AN, MM, KF, MO, JM, MI, TA, KK, and HA approved the final version of the manuscript to be published.

Corresponding author

Correspondence to Yozo Suzuki.

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Disclosures

None of the authors: Yozo Suzuki, Mitsyoshi Tei, Masaki Wakasugi, Toru Masuzawa, Masahisa Ohtsuka, Manabu Mikamori, Takuro Saito, Kenta Furukawa, Mitsunobu Imasato, Kentaro Kishi, Masahiro Tanemura, or Hiroki Akamatsu has a conflict of interest or financial tie to disclose.

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The present manuscript is an original contribution not previously published and not under consideration for publication elsewhere, and, if accepted, will not be published anywhere in similar form, in any language. All authors have read and approved the manuscript, and the study was approved by the institutional research ethics committee.

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Suzuki, Y., Tei, M., Wakasugi, M. et al. Long-term outcomes of single-incision versus multiport laparoscopic colectomy for colon cancer: results of a propensity score-based analysis. Surg Endosc 36, 1027–1036 (2022). https://doi.org/10.1007/s00464-021-08367-4

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