Long-term oncological outcome of reduced-port laparoscopic surgery (single-incision plus one port) as a technical option for rectal cancer.
laparoscopy
minimally invasive surgical procedure
rectal neoplasms
Journal
Asian journal of endoscopic surgery
ISSN: 1758-5910
Titre abrégé: Asian J Endosc Surg
Pays: Japan
ID NLM: 101506753
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
24
02
2023
accepted:
13
06
2023
medline:
3
10
2023
pubmed:
27
6
2023
entrez:
26
6
2023
Statut:
ppublish
Résumé
The purpose of this study was to clarify the oncological safety of reduced-port laparoscopic surgery (single-incision plus one port) (RPS) for patients with rectal cancer. The clinicopathological data of 63 selected patients with clinical Stage I-III (T1-3 and N0-2) rectal cancer who underwent RPS of radical anterior resection between 2012 and 2017 were retrospectively analyzed. The median distance of tumor from anal verge was 11 cm. Ordinarily, a multiport platform with three channels was placed in the 3-cm umbilical incision, and another 5- or 12-mm port was placed in the right lower abdomen. The median operative time, amount of intraoperative bleeding, number of harvested lymph nodes, and length of distal margin were 272 min, 10 mL, 22 nodes, and 4.0 cm, respectively, and there was one (2%) patient with involvement of the radial margin. There were eight patients (13%) who required additional ports, and one patient (2%) who converted to open surgery. Intra- and postoperative complications occurred in one (2%) and 12 patients (19%), respectively. The median length of postoperative hospital stay was 8 days. The median follow-up period was 79 months, and incisional hernia was observed in 3 (5%) patients at the platform site not the port site, and cancer recurrence occurred in four patients (6%). The 5-year relapse-free and overall survival rates were 100% and 100% in the patients with pathological Stage I disease, 94% and 100% in the patients with pathological Stage II disease, and 83% and 89% in the patients with pathological Stage III disease, respectively. RPS in the selected patients with rectal cancer, performed by an expert laparoscopic surgeon, may be technically safe and oncologically acceptable as well as multiport laparoscopic surgery.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this study was to clarify the oncological safety of reduced-port laparoscopic surgery (single-incision plus one port) (RPS) for patients with rectal cancer.
METHODS
METHODS
The clinicopathological data of 63 selected patients with clinical Stage I-III (T1-3 and N0-2) rectal cancer who underwent RPS of radical anterior resection between 2012 and 2017 were retrospectively analyzed. The median distance of tumor from anal verge was 11 cm. Ordinarily, a multiport platform with three channels was placed in the 3-cm umbilical incision, and another 5- or 12-mm port was placed in the right lower abdomen.
RESULTS
RESULTS
The median operative time, amount of intraoperative bleeding, number of harvested lymph nodes, and length of distal margin were 272 min, 10 mL, 22 nodes, and 4.0 cm, respectively, and there was one (2%) patient with involvement of the radial margin. There were eight patients (13%) who required additional ports, and one patient (2%) who converted to open surgery. Intra- and postoperative complications occurred in one (2%) and 12 patients (19%), respectively. The median length of postoperative hospital stay was 8 days. The median follow-up period was 79 months, and incisional hernia was observed in 3 (5%) patients at the platform site not the port site, and cancer recurrence occurred in four patients (6%). The 5-year relapse-free and overall survival rates were 100% and 100% in the patients with pathological Stage I disease, 94% and 100% in the patients with pathological Stage II disease, and 83% and 89% in the patients with pathological Stage III disease, respectively.
CONCLUSION
CONCLUSIONS
RPS in the selected patients with rectal cancer, performed by an expert laparoscopic surgeon, may be technically safe and oncologically acceptable as well as multiport laparoscopic surgery.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
687-694Subventions
Organisme : Chugai Pharmaceutical
Informations de copyright
© 2023 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.
Références
Braga M, Vignali A, Gianotti L, et al. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg. 2002;236:759-766.
Bonjer HJ, Hop WC, Nelson H, et al. Transatlantic laparoscopically assisted vs open colectomy trials study group. Laparoscopically assisted vs. open colectomy for colon cancer: a meta-analysis. Arch Surg. 2007;142:298-303.
Delaney CP, Chang E, Senagore AJ, Broder M. Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg. 2008;247:819-824.
Fujii S, Akagi T, Inomata M, et al. The Japan clinical oncology group. Transitional impact of short- and long-term outcomes of a randomized controlled trial to evaluate laparoscopic versus open surgery for colorectal cancer from Japan clinical oncology group study JCOG0404. Ann Gastroenterol Surg. 2019;3:301-309.
Li Z, Zhao Q, Bai B, Ji G, Liu Y. Enhanced recovery after surgery programs for laparoscopic abdominal surgery: a systematic review and meta-analysis. World J Surg. 2018;42:3463-3473.
Wang CL, Qu G, Xu HW. The short- and long-term outcomes of laparoscopic versus open surgery for colorectal cancer: a meta-analysis. Int J Colorectal Dis. 2014;29:309-320.
Lurje G, Raptis DA, Steinemann DC, et al. Cosmesis and body image in patients undergoing single-port versus conventional laparoscopic cholecystectomy: a multicenter double-blinded randomized controlled trial (SPOCC-trial). Ann Surg. 2015;262:728-735.
Negoi I, Hostiuc S, Negoi RI, Beuran M. Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: a systematic review and meta-analysis. World J Gastrointest Oncol. 2017;9:475-491.
Acuna SA, Chesney TR, Ramjist JK, Shah PS, Kennedy ED, Baxter NN. Laparoscopic versus open resection for rectal cancer. A noninferiority meta-analysis of quality of surgical resection outcomes. Ann Surg. 2019;269:849-855.
Borodulin O, Stockwell E, Howard D. Cosmetic surgery-use of 3mm ports and reduced-port techniques for gynecologic surgery. Surg Technol Int. 2020;36:153-156.
Krinalkumar M, Arun D. Reduced port laparoscopic cholecystectomy: an innovative, cost-effective technique with superior cosmetic outcomes. Surg Technol Int. 2019;35:85-91.
Hamabe A, Takemasa I, Hata T, Mizushima T, Doki Y, Mori M. Patient body image and satisfaction with surgical wound appearance after reduced port surgery for colorectal diseases. World J Surg. 2016;40:1748-1754.
Ahmed K, Wang TT, Patel VM, et al. The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc. 2011;25:378-396.
Sandberg EM, la Chapelle CF, van den Tweel MM, Schoones JW, Jansen FW. Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017;295:1089-1103.
Chen WT, Chang SC, Chiang HC, et al. Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc. 2011;25:1887-1892.
Raman JD, Bagrodia A, Cadeddu JA. Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence. Eur Urol. 2009;55:1198-1204.
Chambers WM, Bicsak M, Lamparelli M, Dixon AR. Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis. 2011;13:393-398.
Ishii Y, Yahagi M, Ochiai H, et al. Short-term and midterm outcomes of single-incision laparoscopic surgery for right-sided colon cancer. Asian J Endosc Surg. 2019;12:275-280.
Ishii Y, Hasegawa H, Endo T, Ochiai H, Okabayashi K, Kitagawa Y. Reduced-port laparoscopic surgery for rectal cancer: feasibility based on our early experience. Asian J Endosc Surg. 2013;6:249-252.
Yamamoto S, Watanabe M, Hasegawa H, Kitajima M. Prospective evaluation of laparoscopic surgery for rectosigmoidal and rectal carcinoma. Dis Colon Rectum. 2002;45:1648-1654.
Hasegawa H, Ishii Y, Nishibori H, Endo T, Watanabe M, Kitajima M. Short- and midterm outcomes of laparoscopic surgery compared for 131 patients with rectal and rectosigmoid cancer. Surg Endosc. 2007;21:920-924.
Gu C, Wu Q, Zhang X, Wei M, Wang Z. Single-incision versus conventional multiport laparoscopic surgery for colorectal cancer: a meta-analysis of randomized controlled trials and propensity-score matched studies. Int J Colorectal Dis. 2021;36:1407-1419.
Morales-Conde S, Peeters A, Meyer YM, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc. 2019;33:996-1019.
Tei M, Sueda T, Matsumura T, et al. Systematic review of single-port vs. multi-port surgery for rectal cancer. Mol Clin Oncol. 2021;14:24.
Liu X, Li JB, Shi G, Guo R, Zhang R. Systematic review of single-incision versus conventional multiport laparoscopic surgery for sigmoid colon and Rectal cancer. World J Surg Oncol. 2018;16:220.
Cavaliere D, Popivanov G, Cassini D, et al. Is a drain necessary after anterior resection of the rectum? A systematic review and meta-analysis. Int J Colorectal Dis. 2019;34:973-981.
Feng Q, Yuan W, Li T, et al. REAL study group. Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol. 2022;7:991-1004.
Prete FP, Pezzolla A, Prete F, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2018;267:1034-1046.
Udayasiri DK, Skandarajah A, Hayes IP. Laparoscopic compared with open resection for colorectal cancer and long-term incidence of adhesional intestinal obstruction and incisional hernia: a systematic review and meta-analysis. Dis Colon Rectum. 2020;63:101-112.
Baik SH, Gincherman M, Mutch MG, Birnbaum EH, Fleshman JW. Laparoscopic vs open resection for patients with rectal cancer: comparison of perioperative outcomes and long-term survival. Dis Colon Rectum. 2011;54:6-14.
Draeger T, Völkel V, Gerken M, Klinkhammer-Schalke M, Fürst A. Long-term oncologic outcomes after laparoscopic versus open rectal cancer resection: a high-quality population-based analysis in a southern German district. Surg Endosc. 2018;32:4096-4104.
Fleshman J, Branda ME, Sargent DJ, et al. Disease free survival and local recurrence for laparoscopic resection compared with open resection of stage II to III rectal cancer: follow-up results of the ACOSOG Z6051 randomized controlled trial. Ann Surg. 2019;269:589-595.
Park JW, Kang SB, Hao J, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): 10-year follow-up of an open-label, non-inferiority, randomised controlled trial. Lancet Gastroenterol Hepatol. 2021;6:569-577.
Tei M, Suzuki Y, Ohtsuka M, et al. Comparison of clinical outcomes of single-incision versus multi-port laparoscopic surgery for rectosigmoid or upper rectal cancer. Int J Colorectal Dis. 2022;37:1553-1560.
Hirano Y, Hiranuma C, Hattori M, Douden K. Long-term oncologic outcomes of single-incision plus one-port laparoscopic surgery for rectal cancer. Indian J Surg. 2021;83:691-695.