Abstract
Background
Single-incision laparoscopic surgery (SILS) is a new minimally invasive technique which has frequently been applied for treatment of benign colorectal diseases. However, there is still little experience with this technique for the treatment of colorectal cancer.
Methods
Sixty-eight patients with SILS resections for colon (n = 25) or rectal cancer (n = 43) were compared to a group of conventionally operated patients who were matched for surgical procedure, tumor stage and tumor location, and the use of preoperative radiochemotherapy.
Results
Both groups were comparable for lymph node harvest, specimen length, and the duration of surgery. No significant differences were observed for the number of positive circumferential resection margins, or the distance of the tumor to both the aboral or lateral resection margin, but two positive resection margins were only present after SILS and not after conventional surgery. Hospitalization tended to be shorter after SILS (p = 0.097). Overall, morbidity was equivalent between the two groups, with a difference for colon cancer where it was significantly lower after SILS as compared to open surgery (p = 0.025) mainly due to a lower rate of wound complications.
Conclusion
SILS might be an acceptable alternative to open surgery for the treatment of colon cancer. For rectal cancer, no apparent benefit could be documented. As no sufficient data on the oncologic quality are available, single-incision laparoscopic surgery can yet not be recommended for the treatment of rectal cancer out of clinical trials.
Similar content being viewed by others
References
Vestweber B, Galetin T, Lammerting K, Paul C, Giehl J, Straub E et al (2013) Single-incision laparoscopic surgery: outcomes from 224 colonic resections performed at a single center using SILS. Surg Endosc 27(2):434–42, Epub 2012/07/19
Vestweber B, Alfes A, Paul C, Haaf F, Vestweber KH (2010) Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease. Surg Endosc 24(12):3225–8, Epub 2010/05/14
Gash KJ, Goede AC, Kaldowski B, Vestweber B, Dixon AR (2011) Single incision laparoscopic (SILS) restorative proctocolectomy with ileal pouch-anal anastomosis. Surg Endosc 25(12):3877–80, Epub 2011/07/16
Leblanc F, Makhija R, Champagne BJ, Delaney CP (2011) Single incision laparoscopic total colectomy and proctocolectomy for benign disease: initial experience. Colorectal disease: Off J Assoc Coloproctology of Great Britain and Ireland 13(11):1290–3, Epub 2010/10/20
Rijcken E, Mennigen R, Argyris I, Senninger N, Bruewer M (2012) Single-incision laparoscopic surgery for ileocolic resection in Crohn’s disease. Dis Colon Rectum 55(2):140–6, Epub 2012/01/10
Yang TX, Chua TC (2013) Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies. Int J Color Dis 28(1):89–101, Epub 2012/07/26
Green BL, Marshall HC, Collinson F, Quirke P, Guillou P, Jayne DG et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100(1):75–82, Epub 2012/11/08
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–9, Epub 2002/07/10
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(7):477–84, Epub 2005/07/05
van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–8, Epub 2013/02/12
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–26, Epub 2005/05/17
Rink AD, Vestweber B, Paul C, Vestweber KH. Lymph node harvest in single incision laparoscopic surgery for colorectal malignancy. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2013. Epub 2013/12/12.
Tekkis PP, Smith JJ, Heriot AG, Darzi AW, Thompson MR, Stamatakis JD (2006) A national study on lymph node retrieval in resectional surgery for colorectal cancer. Dis Colon Rectum 49(11):1673–83, Epub 2006/10/05
Nagtegaal ID, van de Velde CJ, van der Worp E, Kapiteijn E, Quirke P, van Krieken JH (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J clin oncol : off j Am Soc Clin Oncol 20(7):1729–34, Epub 2002/03/29
Holm T, Ljung A, Haggmark T, Jurell G, Lagergren J (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94(2):232–8, Epub 2006/12/05
Fung AK, Aly EH (2012) Systematic review of single-incision laparoscopic colonic surgery. Br J Surg 99(10):1353–64, Epub 2012/09/11
Zhou YM, Wu LP, Zhao YF, Xu DH, Li B (2012) Single-incision versus conventional laparoscopy for colorectal disease: a meta-analysis. Dig Dis Sci 57(8):2103–12, Epub 2012/04/03
Huscher CG, Mingoli A, Sgarzini G, Mereu A, Binda B, Brachini G et al (2012) Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. Am J Surg 204(1):115–20, Epub 2011/12/20
Yun JA, Yun SH, Park YA, Cho YB, Kim HC, Lee WY et al (2013) Single-incision laparoscopic right colectomy compared with conventional laparoscopy for malignancy: assessment of perioperative and short-term oncologic outcomes. Surg Endosc 27(6):2122–30, Epub 2013/01/16
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rink, A.D., Vestweber, B., Paul, C. et al. Single-incision laparoscopic surgery for colorectal malignancy—results of a matched-pair comparison to conventional surgery. Int J Colorectal Dis 30, 79–85 (2015). https://doi.org/10.1007/s00384-014-2041-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-014-2041-5