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Surg Endosc. 2017 Jun;31(6):2437-2450. doi: 10.1007/s00464-016-5244-8. Epub 2016 Oct 5.

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

Liu R1,2,3,4, Wang Y1, Zhang Z1,5,3,4, Li T1, Liu H1, Zhao L1, Deng H6, Li G7.

Author information

1
Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China.
2
Department of Gynecological Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
3
Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
4
Tianjin's Clinical Research Center for Cancer, Tianjin, China.
5
Department of Head and Neck Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.
6
Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China. navyd999@163.com.
7
Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China. gzliguoxin@163.com.

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.

KEYWORDS:

Colorectal cancer; Cosmesis; Inflammatory responses; Propensity score; Rectosigmoid; Single-incision laparoscopic surgery

PMID:
27709329
DOI:
10.1007/s00464-016-5244-8
[Indexed for MEDLINE]

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