Top

International Journal of Colorectal Disease

Published in:

Open Access 01-12-2024 | Incision | REVIEW

Single-incision plus one-port laparoscopy surgery versus conventional multi-port laparoscopy surgery for colorectal cancer: a systematic review and meta-analysis

Authors: Jian Kong, Meng-qi Wu, Shuai Yan, Zheng-fei Zhao, Hui Yao

Published in: International Journal of Colorectal Disease | Issue 1/2024

Abstract

Objective

The efficacy of single-incision plus one-port laparoscopic surgery (SILS + 1) versus conventional laparoscopic surgery (CLS) for colorectal cancer treatment remains unclear. This study compares the short-term and long-term outcomes of SILS + 1 and CLS using a high-quality systematic review and meta-analysis.

Method

Literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, drawing from PubMed, Embase, Web of Science, and the Cochrane Library until December 10, 2023. Statistical analysis was conducted using RevMan and Stata.

Result

The review and meta-analysis included seven studies with 1740 colorectal cancer patients. Compared to CLS, SILS + 1 showed significant improvements in operation time (WMD = − 18.33, P < 0.00001), blood loss (WMD = − 21.31, P < 0.00001), incision length (WMD = − 2.07, P < 0.00001), time to first defecation (WMD = − 14.91, P = 0.009), time to oral intake (WMD = − 11.46, P = 0.04), and time to ambulation (WMD = − 11.52, P = 0.01). There were no significant differences in lymph node harvest, resection margins, complications, anastomotic leakage, hospital stay, disease-free survival, overall survival, and postoperative recurrence.

Conclusions

Compared to CLS, SILS + 1 demonstrates superiority in shortening the surgical incision and promoting postoperative recovery. SILS + 1 can provide a safe and feasible alternative to CLS.

Available only for authorised users

Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150PubMed

Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. The Lancet. Oncology 15:767–774. https://doi.org/10.1016/S1470-2045(14)70205-0CrossRefPubMed

Kuipers EJ, Grady WM, Lieberman D et al (2015) Colorectal cancer. Nat Rev Dis Primers. https://doi.org/10.1038/nrdp.2015.65CrossRefPubMedPubMedCentral

Green BL, Marshall HC, Collinson F et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Brit J Surg 100:75–82. https://doi.org/10.1002/bjs.8945CrossRefPubMed

Biebl MO, Schirnhofer J, Weiss HG (2015) Single incision laparoscopic surgery for colorectal cancer. Ann Surg. https://doi.org/10.1097/SLA.0000000000000567CrossRefPubMed

Grossi U, Piccino M, Sarli L (2024) Single-incision laparoscopic Sarli procedure: subtotal colectomy with antiperistaltic caecorectal anastomosis for slow-transit constipation - a video vignette. Colorectal Dis. https://doi.org/10.1111/codi.16963CrossRefPubMed

Xu YH, Wang FR (2024) Transumbilical single-incision hybrid pyeloplasty for infant ureteropelvic junction obstruction. J Pediatr Urol. https://doi.org/10.1016/j.jpurol.2024.03.021CrossRefPubMed

Poon JTC, Cheung C-W, Fan JKM et al (2012) Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc 26:2729–2734CrossRefPubMed

Takemasa I, Uemura M, Nishimura J et al (2014) Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer: a prospective case-control comparison. Surg Endosc 28:1110–1118. https://doi.org/10.1007/s00464-013-3284-xCrossRefPubMed

10.

Kim CW, Cho MS, Baek SJ et al (2015) Oncologic outcomes of single-incision versus conventional laparoscopic anterior resection for sigmoid colon cancer: a propensity-score matching analysis. Ann Surg Oncol 22:924–930. https://doi.org/10.1245/s10434-014-4039-1CrossRefPubMed

11.

Fujii S, Watanabe K, Ota M et al (2012) Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case-control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost. Surg Endosc 26:1403–1411. https://doi.org/10.1007/s00464-011-2047-9CrossRefPubMed

12.

Goel R, Lomanto D (2012) Controversies in single-port laparoscopic surgery. Surgical Laparoscopy. Endosc Percutan Tech 22:380–382. https://doi.org/10.1097/SLE.0b013e3182615776CrossRef

13.

Yun JA, Yun SH, Park YA (2016) Oncologic outcomes of single-incision laparoscopic surgery compared with conventional laparoscopy for colon cancer. Ann Surg 263:973–978. https://doi.org/10.1097/SLA.0000000000001226CrossRefPubMed

14.

Gash K, Bicsak M, Dixon A (2015) Single-incision laparoscopic surgery for rectal cancer: early results and medium-term oncological outcome. Colorectal Dis Official J Assoc Coloproctology Great Britain Ireland 17:1071–1078. https://doi.org/10.1111/codi.13034CrossRef

15.

Jiang F, Ji M, Jin F (2023) Clinical application of two-port laparoscopic surgery in sigmoid colon and upper rectal cancer resection. Front Oncol. https://doi.org/10.3389/fonc.2023.1248280CrossRefPubMedPubMedCentral

16.

Kawamata F, Homma S, Minagawa N et al (2014) Comparison of single-incision plus one additional port laparoscopy-assisted anterior resection with conventional laparoscopy-assisted anterior resection for rectal cancer. World J Surg 38:2716–2723. https://doi.org/10.1007/s00268-014-2642-8CrossRefPubMed

17.

Yu H, Shin JY (2016) Short-term outcomes following reduced-port, single-port, and multi-port laparoscopic surgery for colon cancer: tailored laparoscopic approaches based on tumor size and nodal status. Int J Colorectal Dis 31:115–122. https://doi.org/10.1007/s00384-015-2399-zCrossRefPubMed

18.

Wang Y, Deng H, Mou T et al (2019) Short-term outcomes of single-incision plus one-port laparoscopic versus conventional laparoscopic surgery for rectosigmoid cancer: a randomized controlled trial. Surg Endosc 33:840–848. https://doi.org/10.1007/s00464-018-6350-6CrossRefPubMed

19.

Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical Research ed). https://doi.org/10.1136/bmj.b2700CrossRefPubMed

20.

Zhao JH, Sun JX, Gao P et al (2014) Fast-track surgery versus traditional perioperative care in laparoscopic colorectal cancer surgery: a meta-analysis. BMC Cancer. https://doi.org/10.1186/1471-2407-14-607CrossRefPubMedPubMedCentral

21.

Tierney JF, Stewart LA, Ghersi D et al (2007) Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 8:16CrossRefPubMedPubMedCentral

22.

Corbett MS, Higgins JPT, Woolacott NF (2014) Assessing baseline imbalance in randomised trials: implications for the Cochrane risk of bias tool. Res Synth Methods 5:79–85. https://doi.org/10.1002/jrsm.1090CrossRefPubMed

23.

Sterne JA, Hernán MA, Reeves BC et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Clinical Research ed). https://doi.org/10.1136/bmj.i4919CrossRefPubMed

24.

Kang JH, Lee SY, Kim CH et al (2018) Comparison of the short-term outcomes of reduced-port laparoscopic surgery and conventional multiport surgery in colon cancer: a propensity score matching analysis. Ann Surg Treat Res 94:147–153. https://doi.org/10.4174/astr.2018.94.3.147CrossRefPubMedPubMedCentral

25.

Liu R, Wang Y, Zhang Z et al (2017) Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery. Surg Endosc 31:2437–2450. https://doi.org/10.1007/s00464-016-5244-8CrossRefPubMed

26.

Wu M, Wang H, Zhang X (2023) Short-term and long-term outcomes of single-incision plus one-port laparoscopic surgery for colorectal cancer: a propensity-matched cohort study with conventional laparoscopic surgery. BMC Gastroenterol. https://doi.org/10.1186/s12876-023-03058-xCrossRefPubMedPubMedCentral

27.

Song JM, Kim JH, Lee YS et al (2016) Reduced port laparoscopic surgery for colon cancer is safe and feasible in terms of short-term outcomes: comparative study with conventional multiport laparoscopic surgery. Ann Surg Treat Res 91:195–201. https://doi.org/10.4174/astr.2016.91.4.195CrossRefPubMedPubMedCentral

28.

Wu HW, Zheng ZJ, Xu LW et al (2020) Short- and medium-term outcomes of reduced-port laparoscopic surgery in elderly patients with upper rectal cancer: a retrospective cohort study. Cancer Medicine 9:5320–5326. https://doi.org/10.1002/cam4.3070CrossRefPubMedPubMedCentral

29.

Zhang X, Yuan H, Tan Z et al (2023) Long-term outcomes of single-incision plus one-port laparoscopic surgery versus conventional laparoscopic surgery for rectosigmoid cancer: a randomized controlled trial. BMC Cancer. https://doi.org/10.1186/s12885-023-11500-2CrossRefPubMedPubMedCentral

30.

Yu H, Shin JY (2016) Short-term outcomes following reduced-port, single-port, and multi-port laparoscopic surgery for colon cancer: tailored laparoscopic approaches based on tumor size and nodal status. Int J Colorectal Dis 31:115–22. https://doi.org/10.1007/s00384-015-2399-zCrossRefPubMed

31.

Harbord RM, Egger M, Sterne JAC (2006) A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 25:3443–3457CrossRefPubMed

32.

Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016. https://doi.org/10.1007/s00384-008-0519-8CrossRefPubMed

33.

Remzi FH, Kirat HT, Kaouk JH et al (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis : Official J Assoc Coloproctology Great Britain Ireland 10:823–826. https://doi.org/10.1111/j.1463-1318.2008.01660.xCrossRef

34.

ElSherbiney M, Khawaja AH, Noureldin K et al (2023) Single incision laparoscopy versus conventional multiport laparoscopy for colorectal surgery: a systematic review and meta-analysis. Ann Royal College Surg England 105:709–720. https://doi.org/10.1308/rcsann.2022.0132CrossRef

35.

Kawamata F, Homma S, Minagawa N et al (2014) Comparison of single-incision plus one additional port laparoscopy-assisted anterior resection with conventional laparoscopy-assisted anterior resection for rectal cancer. World J Surg 38:2716–23. https://doi.org/10.1007/s00268-014-2642-8CrossRefPubMed

36.

Li FH, Zeng DX, Chen L et al (2022) Comparison of clinical efficacy of single-incision and traditional laparoscopic surgery for colorectal cancer: a meta-analysis of randomized controlled trials and propensity-score matched studies. Front Oncol. https://doi.org/10.3389/fonc.2022.997894CrossRefPubMedPubMedCentral

37.

Hirano Y, Hattori M, Douden K et al (2018) Short-term clinical and oncological outcomes after single-incision plus one port laparoscopic anterior resection for rectal cancer. Dig Surg 35:111–115. https://doi.org/10.1159/000475872CrossRefPubMed

38.

Kwak JY, Yang KM, Han MS (2020) Feasibility of single-incision plus one port laparoscopic low anterior resection for rectal cancer. J Minim Invasive Surg 23:120–125. https://doi.org/10.7602/jmis.2020.23.3.120CrossRefPubMedPubMedCentral

39.

Adair J, Gromski MA, Lim RB et al (2010) Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport laparoscopic right colectomy. Dis Colon Rectum 53:1549–54. https://doi.org/10.7602/jmis.2020.23.3.120CrossRefPubMed

40.

Li MZ, Li KY, Shen J et al (2020) Clavien-Dindo classification of complications after complete mesocolic excision in laparoscopic radical resection of right hemicolon cancer and analysis on its influencing factors. Zhonghua Wei Chang Wai Ke Za Zhi = Chinese Journal of Gastrointestinal Surgery 23:51–55. https://doi.org/10.3760/cma.j.issn.1671-0274.2020.01.009

41.

Mao D, Flynn DE, Yerkovich S et al (2022) Effect of obesity on post-operative outcomes following colorectal cancer surgery. World J Gastrointest Oncol 14:1324–1336. https://doi.org/10.4251/wjgo.v14.i7.1324CrossRefPubMedPubMedCentral

42.

Horowitz JA, Jain A, Puvanesarajah V et al (2018) Risk factors, additional length of stay, and cost associated with postoperative ileus following anterior lumbar interbody fusion in elderly patients. World Neurosurg 115:e185–e189. https://doi.org/10.1016/j.wneu.2018.04.006CrossRefPubMed

43.

Egi H, Hattori M, Hinoi T et al (2012) Single-port laparoscopic colectomy versus conventional laparoscopic colectomy for colon cancer: a comparison of surgical results. World J Surg Oncol. https://doi.org/10.1186/1477-7819-10-61CrossRefPubMedPubMedCentral

44.

Lim SW, Kim HJ, Kim CH et al (2013) Umbilical incision laparoscopic colectomy with one additional port for colorectal cancer. Tech Coloproctol 17:193–199. https://doi.org/10.1007/s10151-012-0900-zCrossRefPubMed

45.

Wang YN, Deng HJ, Mou TY et al (2019) Short-term outcomes of single-incision plus one-port laparoscopic versus conventional laparoscopic surgery for rectosigmoid cancer: a randomized controlled trial. Surg Endosc Other Int Tech 33:840–848. https://doi.org/10.1007/s00464-018-6350-6CrossRef

46.

Zhang Y, Zheng B (2022) Familiarity of surgical teams: impact on laparoscopic procedure time. Am J Surg 224:1280–1284. https://doi.org/10.1016/j.amjsurg.2022.06.002CrossRefPubMed

47.

Lim SW, Kim HJ, Kim CH et al (2013) Umbilical incision laparoscopic colectomy with one additional port for colorectal cancer. Tech Coloproctol 17:193–9. https://doi.org/10.1007/s10151-012-0900-zCrossRefPubMed

48.

van den Boezem PB, Sietses C (2011) Single-incision laparoscopic colorectal surgery, experience with 50 consecutive cases. J Gastrointest Surg 15:1989–94. https://doi.org/10.1007/s11605-011-1626-3CrossRefPubMed

49.

Dong B, Luo Z, Lu J et al (2018) Single-incision laparoscopic versus conventional laparoscopic right colectomy: a systematic review and meta-analysis. Int J Surg 55:31–38. https://doi.org/10.1016/j.ijsu.2018.05.013CrossRefPubMed

Title: Single-incision plus one-port laparoscopy surgery versus conventional multi-port laparoscopy surgery for colorectal cancer: a systematic review and meta-analysis
Authors: Jian Kong
Meng-qi Wu
Shuai Yan
Zheng-fei Zhao
Hui Yao
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Incision
Laparoscopy
Colorectal Cancer
Colorectal Cancer
Published in: International Journal of Colorectal Disease / Issue 1/2024
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-024-04630-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Single-incision plus one-port laparoscopy surgery versus conventional multi-port laparoscopy surgery for colorectal cancer: a systematic review and meta-analysis

Abstract

Objective

Method

Result

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Method

Result

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis

Robotic transanal minimally invasive surgery (R-TAMIS): current evidence in the treatment of early rectal neoplasia

Adjuvant chemotherapy decision-making in stage II colon adenocarcinoma associated with patients’ age and high-risk factors

A novel classification of posterior pelvic exenteration to assess prognosis in female patients with locally advanced primary rectal cancer: a retrospective cohort study from China PelvEx collaborative

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

Endoscopic and trans-anal local excision vs. radical resection in the treatment of early rectal cancer: A systematic review and network meta-analysis