Abstract
Background
The benefit of single-incision laparoscopy (SIL) over conventional multiport laparoscopy (ML) is not demonstrated in colorectal surgery, mainly because of potentially biased reports. The objective of this study was to compare SIL to ML for colorectal resection, using a propensity score (PS) adjusted analysis.
Methods
From July 2009 to April 2013, 764 patients who underwent 799 colorectal resections by SIL or ML were analyzed. PS was estimated using a logistic regression model.
Results
Eighty-four colorectal resections were performed using SIL: 43 ileocolic resections, 15 right-sided colectomies, 14 left-sided colectomies, 5 rectal resections, 4 subtotal colectomies, and 3 total proctocolectomies. Intra-operative complications occurred in 3 procedures (4 %), and conversion laparotomy in 10 (12 %). Postoperative mortality was nil and overall morbidity rate was 25 %, including 7 % of major complications. Mean postoperative length of hospital stay was 8 ± 6 (4–47) days. Outcomes of SIL, when compared to those of 715 ML and after PS adjustment, showed no difference in terms of intra-operative complication (p = 0.315), conversion to open surgery (p = 0.387), overall morbidity (p = 0.393), major morbidity (p = 0.381), or length of postoperative hospital stay (p = 0.080). However, the length of hospital stay was significantly shorter after SIL in the right colectomy subgroup (p = 0.001).
Conclusions
In colorectal surgery, SIL appears to be safe and effective as compared to ML. It can also reduce hospital stay after right colectomy. These results, if confirmed by randomized trials, would validate SIL in colorectal surgery.
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References
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Lujan J, Valero G, Hernandez Q, Sanchez A, Frutos MD, Parrilla P (2009) Randomized clinical trial comparing laparoscopic and open surgery in patients with rectal cancer. Br J Surg 96:982–989
Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H, Clinical Outcomes of Surgical Therapy Study G (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–664
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
Maggiori L, Gaujoux S, Tribillon E, Bretagnol F, Panis Y (2012) Single-incision laparoscopy for colorectal resection: a systematic review and meta-analysis of more than a thousand procedures. Colorectal Dis 14:e643–e654
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
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
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
Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K, de Chirurgie AF (2005) Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 140:278–284
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Benoist S, Panis Y, Beaufour A, Bouhnik Y, Matuchansky C, Valleur P (2003) Laparoscopic ileocecal resection in Crohn’s disease: a case-matched comparison with open resection. Surg Endosc 17:814–818
Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y (2007) Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery 141:640–644
Lefevre JH, Bretagnol F, Ouaissi M, Taleb P, Alves A, Panis Y (2009) Total laparoscopic ileal pouch-anal anastomosis: prospective series of 82 patients. Surg Endosc 23:166–173
Maggiori L, Bretagnol F, Alves A, Panis Y (2010) Laparoscopic subtotal colectomy for acute or severe colitis with double-end ileo-sigmoidostomy in right iliac fossa. Surg Laparosc Endosc Percutan Tech 20:27–29
Gaujoux S, Bretagnol F, Au J, Ferron M, Panis Y (2011) Single port access proctectomy with total mesorectal excision and intersphincteric resection with a primary transanal approach. Colorectal Dis 13:e305–e307
Bretagnol F, Panis Y, Rullier E, Rouanet P, Berdah S, Dousset B, Portier G, Benoist S, Chipponi J, Vicaut E (2010) Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg 252:863–868
Sato T, Matsuyama Y (2003) Marginal structural models as a tool for standardization. Epidemiology 14:680–686
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
Geisler D, Garrett T (2011) Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases. Tech Coloproctol 15:397–401
Lee SW, Milsom JW, Nash GM (2011) Single-incision versus multiport laparoscopic right and hand-assisted left colectomy: a case-matched comparison. Dis Colon Rectum 54:1355–1361
Disclosures
Antoine Khayat, Léon Maggiori, Eric Vicaut, Marianne Ferron, and Yves Panis have no conflicts of interest or financial ties to disclose.
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Khayat, A., Maggiori, L., Vicaut, E. et al. Does single port improve results of laparoscopic colorectal surgery? A propensity score adjustment analysis. Surg Endosc 29, 3216–3223 (2015). https://doi.org/10.1007/s00464-015-4063-7
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DOI: https://doi.org/10.1007/s00464-015-4063-7