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Clinical and oncological outcomes of single-incision vs. conventional laparoscopic surgery for rectal cancer

Abstract

Background

To evaluate the clinical and oncological outcomes of single-incision laparoscopic surgery (SILS) vs. conventional laparoscopic surgery (CLS) for patients with rectal cancer (RC) who underwent total mesorectal excision (TME) surgery.

Methods

This was a retrospective case–control study of patients with RC operated between 12/2013 and 12/2017 in Ruijin Hospital North, Shanghai Jiaotong University School of Medicine. In total, 177 patients who underwent CLS and 51 who underwent SILS met the inclusion and exclusion criteria and were matched 1:1 using propensity score matching method (PSM).

Results

Compared with the CLS group, the SILS group showed shorter operation time [105 (40) vs. 125 (55) min, P = 0.045], shorter total incision length [4 (1) vs. 6.5 (1.5) cm, P < 0.001], lower VAS score on POD2 [1 (1) vs. 2 (1), P < 0.001], shorter time to soft diet [7 (1) vs. 8 (2) days, P = 0.048], and shorter length of hospital stay [9 (2) vs. 11 (3) days, P < 0.001]. The postoperative complications were similar between two groups [1(2%) vs. 5 (9.8%), P = 0.205]. No readmissions or mortality in either group occurred within 30 days of surgery. All 102 specimens met the requirements of TME. No significant differences were observed in the pathologic outcomes between the two groups. The median follow-up period was 32.6 months in the SILS group and 36.8 months in the CLS group (P = 0.053). The 3-year disease-free survival rates and overall survival rates of the SILS and CLS groups were 89.8% vs. 96.0% (P = 0.224) and 90.9% vs. 96.9% (P = 0.146), respectively.

Conclusions

Compared with CLS, TME surgery for rectal cancer can be performed safely and effectively using the SILS technique with better cosmetic results, less postoperative pain, faster postoperative recovery, and acceptable clinical and oncological outcomes.

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Funding

This study was supported by Advanced and Appropriate Technology Promotion Projects of Shanghai Municipal Health Commission (2019SY058). It had no involvement in study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Author information

Correspondence to Xiaopin Ji or Ren Zhao.

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Disclosures

Yimei Jiang, Zijia Song, Xi Cheng, Kun Liu, Yiqin Shi, Changgang Wang, You Li, Xiaopin Ji, and Ren Zhao have no conflicts of interest or financial ties to disclose.

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Jiang, Y., Song, Z., Cheng, X. et al. Clinical and oncological outcomes of single-incision vs. conventional laparoscopic surgery for rectal cancer. Surg Endosc (2019). https://doi.org/10.1007/s00464-019-07317-5

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Keywords

  • Rectal cancer
  • Single-incision laparoscopic surgery
  • Total mesorectal excision
  • Oncologic outcomes