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



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.


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).


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.


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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  1. 1.

    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386

    CAS  Article  Google Scholar 

  2. 2.

    Moon SY, Kim S, Lee SY, Han EC, Kang SB, Jeong SY, Park KJ, Oh JH, SEoul COlorectal Group (SECOG) (2016) Laparoscopic surgery for patients with colorectal cancer produces better short-term outcomes with similar survival outcomes in elderly patients compared to open surgery. Cancer Med 5:1047–1054

    Article  Google Scholar 

  3. 3.

    Julien M, Dove J, Quindlen K, Halm K, Shabahang M, Wild J, Blansfield J (2016) Evolution of laparoscopic surgery for colorectal cancer: the impact of the clinical outcomes of surgical therapy group trial. Am Surg 82:685–691

    Article  Google Scholar 

  4. 4.

    Askari A, Nachiappan S, Currie A, Bottle A, Athanasiou T, Faiz O (2016) Selection for laparoscopic resection confers a survival benefit in colorectal cancer surgery in England. Surg Endosc 30:3839–3847

    Article  Google Scholar 

  5. 5.

    Cuccurullo D, Pirozzi F, Sciuto A, Bracale U, La Barbera C, Galante F, Corcione F (2015) Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center. Surg Endosc 29:1795–1803

    Article  Google Scholar 

  6. 6.

    Azin A, Saleh F, Cleghorn M, Yuen A, Jackson T, Okrainec A, Quereshy FA (2017) A comparison of endoscopic localization error rate between operating surgeons and referring endoscopists in colorectal cancer. Surg Endosc 31:1318–1326

    Article  Google Scholar 

  7. 7.

    Govaert JA, Fiocco M, van Dijk WA, Kolfschoten NE, Prins HA, Dekker JWT, Tollenaar R, Tanis PJ, Wouters M, Dutch Value Based Healthcare Study (2017) Multicenter stratified comparison of hospital costs between laparoscopic and open colorectal cancer resections: influence of tumor location and operative risk. Ann Surg 266:1021–1028

    Article  Google Scholar 

  8. 8.

    Gietelink L, Wouters MW, Bemelman WA, Dekker JW, Tollenaar RA, Tanis PJ (2016) Reduced 30-day mortality after laparoscopic colorectal cancer surgery. Ann Surg 264:135–140

    Article  Google Scholar 

  9. 9.

    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

    Article  Google Scholar 

  10. 10.

    Pascual M, Salvans S, Pera M (2016) Laparoscopic colorectal surgery: current status and implementation of the latest technological innovations. World J Gastroenterol 22:704–717

    CAS  Article  Google Scholar 

  11. 11.

    Steinemann DC, Muller PC, Probst P, Schwarz AC, Buchler MW, Muller-Stich BP, Linke GR (2017) Meta-analysis of hybrid natural-orifice transluminal endoscopic surgery versus laparoscopic surgery. Br J Surg 104:977–989

    CAS  Article  Google Scholar 

  12. 12.

    Rubinkiewicz M, Nowakowski M, Wierdak M, Mizera M, Dembinski M, Pisarska M, Major P, Malczak P, Budzynski A, Pedziwiatr M (2018) Transanal total mesorectal excision for low rectal cancer: a case-matched study comparing TaTME versus standard laparoscopic TME. Cancer Manag Res 10:5239–5245

    Article  Google Scholar 

  13. 13.

    Ma B, Gao P, Song Y, Zhang C, Zhang C, Wang L, Liu H, Wang Z (2016) Transanal total mesorectal excision (taTME) for rectal cancer: a systematic review and meta-analysis of oncological and perioperative outcomes compared with laparoscopic total mesorectal excision. BMC Cancer 16:380

    Article  Google Scholar 

  14. 14.

    Spanheimer PM, Armstrong JG, Fu S, Liao J, Regenbogen SE, Byrn JC (2017) Robotic proctectomy for rectal cancer: analysis of 71 patients from a single institution. Int J Med Robot Comput Assist Surg 13:e1841

    Article  Google Scholar 

  15. 15.

    Chouillard E, Alsabah S, Daher R, Younan A, Greco VJ, Chahine E, Abdullah B, Biagini J (2016) Single-incision laparoscopy could be better than standard laparoscopy in right colectomy for cancer. J Laparoendosc Adv Surg Tech A 26:371–378

    Article  Google Scholar 

  16. 16.

    Keller DS, Flores-Gonzalez JR, Ibarra S, Haas EM (2016) Review of 500 single incision laparoscopic colorectal surgery cases—lessons learned. World J Gastroenterol 22:659–667

    CAS  Article  Google Scholar 

  17. 17.

    Cianchi F, Staderini F, Badii B (2014) Single-incision laparoscopic colorectal surgery for cancer: state of art. World J Gastroenterol 20:6073–6080

    Article  Google Scholar 

  18. 18.

    Gash K, Bicsak M, Dixon A (2015) Single-incision laparoscopic surgery for rectal cancer: early results and medium-term oncological outcome. Colorectal Dis 17:1071–1078

    CAS  Article  Google Scholar 

  19. 19.

    Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016

    Article  Google Scholar 

  20. 20.

    Kim SJ, Choi BJ, Lee SC (2014) Successful total shift from multiport to single-port laparoscopic surgery in low anterior resection of colorectal cancer. Surg Endosc 28:2920–2930

    Article  Google Scholar 

  21. 21.

    Ragupathi M, Ramos-Valadez DI, Yaakovian MD, Haas EM (2011) Single-incision laparoscopic colectomy: a novel approach through a Pfannenstiel incision. Tech Coloproctol 15:61–65

    CAS  Article  Google Scholar 

  22. 22.

    Madhoun N, Keller DS, Haas EM (2015) Review of single incision laparoscopic surgery in colorectal surgery. World J Gastroenterol 21:10824–10829

    CAS  Article  Google Scholar 

  23. 23.

    Rao PP, Rao PP, Bhagwat S (2011) Single-incision laparoscopic surgery-current status and controversies. J Minim Access Surg 7:6–16

    Google Scholar 

  24. 24.

    Trakarnsanga A, Akaraviputh T, Wathanaoran P, Phalanusitthepha C, Methasate A, Chinswangwattanakul V (2011) Single-incision laparoscopic colectomy without using special articulating instruments: an initial experience. World J Surg Oncol 9:162

    Article  Google Scholar 

  25. 25.

    Bulut O, Aslak KK, Levic K, Nielsen CB, Romer E, Sorensen S, Christensen IJ, Nielsen HJ (2015) A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery. Tech Coloproctol 19:11–22

    CAS  Article  Google Scholar 

  26. 26.

    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

    Article  Google Scholar 

  27. 27.

    Bush AJ, Morris SN, Millham FH, Isaacson KB (2011) Women’s preferences for minimally invasive incisions. J Minim Invasive Gynecol 18:640–643

    Article  Google Scholar 

  28. 28.

    Osborne AJ, Lim J, Gash KJ, Chaudhary B, Dixon AR (2013) Comparison of single-incision laparoscopic high anterior resection with standard laparoscopic high anterior resection. Colorectal Dis 15:329–333

    CAS  Article  Google Scholar 

  29. 29.

    Stevenson AR, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, Davies L, Wilson K, Hague W, Simes J (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314:1356–1363

    CAS  Article  Google Scholar 

  30. 30.

    Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, Peters WR Jr, Maun D, Chang G, Herline A, Fichera A, Mutch M, Wexner S, Whiteford M, Marks J, Birnbaum E, Margolin D, Larson D, Marcello P, Posner M, Read T, Monson J, Wren SM, Pisters PW, Nelson H (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314:1346–1355

    CAS  Article  Google Scholar 

  31. 31.

    Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Azuma D, Kohama S (2016) Short-term and long-term outcomes of singleincision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases. Surg Endosc 30:1317–1325

    Article  Google Scholar 

  32. 32.

    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

    Article  Google Scholar 

  33. 33.

    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

    Article  Google Scholar 

  34. 34.

    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 216:1037–1047

    Article  Google Scholar 

  35. 35.

    Antoniou SA, Morales-Conde S, Antoniou GA, Granderath FA, Berrevoet F, Muysoms FE, Bonham G (2016) Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia 20:1–10

    CAS  Article  Google Scholar 

  36. 36.

    Alptekin H, Yilmaz H, Acar F, Kafali ME, Sahin M (2012) Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 22:731–737

    Article  Google Scholar 

  37. 37.

    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

    Article  Google Scholar 

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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.

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Correspondence to Xiaopin Ji or Ren Zhao.

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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 34, 5294–5303 (2020).

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