Welcome to Francis Academic Press

Frontiers in Medical Science Research, 2022, 4(14); doi: 10.25236/FMSR.2022.041404.

Single-port versus conventional multi-port laparoscopic surgery in the treatment of colorectal cancer: A systematic review and meta-analysis

Author(s)

Wei Xu1, Jianqin Lai1, Jin Gong2

Corresponding Author:
Jin Gong
Affiliation(s)

1Jinan University, Guangzhou, China

2The First Affiliated Hospital of Jinan University, Guangzhou, China

Abstract

Objective: To compare the clinical efficacy of single-port laparoscopic surgery (SILS) and conventional multi-port laparoscopic surgery (CMLS) in the treatment of colorectal cancer.Methods: A systematic literature search was performed in Pubmed, Embase, Cochrane library, Web of science and ClinicalTrials.gov. Randomized controlled trials (RCTs) studies comparing SILS and CMLS for colorectal cancer (CRC) were enrolled. Quality assessment was performed using the Cochrane Collaboration’s risk of bias tool. Meta-analysis was performed using Review Manager 5.4.1.Results: Eight RCTs with a total of 1143 patients were finally included. The results of meta-analysis showed that the incision length of SILS group was shorter than that of CMLS group in radical resection of CRC [P = 0.003, MD = -2.64, 95% CI (-4.39, -0.89)], the tumor size in pathological specimens of SILS group was smaller than that of CMLS group [P = 0.008, MD = 0.12, 95% CI (0.03, 0.22)]; while the operation time, intraoperative blood loss, conversion rate, postoperative first anus exhaust time, postoperative first day rest pain score, hospital stay, incidence of postoperative complications, incidence of reoperation, number of dissected lymph nodes, length of pathological specimens, distance from the distal resection margin of the tumor and distance from the proximal resection margin of the tumor was not statistically different between SILS and CMLS.Conclusion: SILS is feasible and safe in the treatment of colorectal cancer, and may be more advantageous in terms of cosmetic results. Long-term outcomes need to be confirmed by larger RCTs with complete follow-up data.

Keywords

Single-port laparoscopic surgery, Conventional multi-port laparoscopic surgery, Meta-analysis, Colorectal cancer

Cite This Paper

Wei Xu, Jianqin Lai, Jin Gong. Single-port versus conventional multi-port laparoscopic surgery in the treatment of colorectal cancer: A systematic review and meta-analysis. Frontiers in Medical Science Research (2022) Vol. 4, Issue 14: 20-36. https://doi.org/10.25236/FMSR.2022.041404.

References

[1] Jacobs M, Verdeja J C, Goldstein H S. Minimally invasive colon resection (laparoscopic colectomy) [J]. Surgical laparoscopy & endoscopy, 1991, 1(3): 144-50.

[2] Kim H J, Lee I K, Lee Y S, et al. A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer [J]. Surgical endoscopy, 2009, 23(8): 1812-7.

[3] Buunen M, Veldkamp R, Hop W C, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial [J]. The Lancet Oncology, 2009, 10(1): 44-52.

[4] Delaney C P, Chang E, Senagore A J, et al. Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database [J]. Annals of surgery, 2008, 247(5): 819-24.

[5] Miyajima N, Fununaga M, Hasegawa H, et al. Results of a multicenter study of 1,057 cases of rectal cancer treated by laparoscopic surgery [J]. Surgical endoscopy, 2009, 23(1): 113-8.

[6] MartelL G, Crawford A, Barkun J S, et al. Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials [J]. PloS one, 2012, 7(4): e35292.

[7] Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy [J]. International journal of colorectal disease, 2008, 23(10): 1013-6.

[8] Remzi F H, Kirat H T, Kaouk J H, et al. Single-port laparoscopy in colorectal surgery [J]. Colorectal disease: the official journal of the Association of Coloproctology of Great Britain and Ireland, 2008, 10(8): 823-6.

[9] Bucher P, Pugin F, Morel P. Single-port access laparoscopic radical left colectomy in humans [J]. Diseases of the colon and rectum, 2009, 52(10): 1797-801.

[10] Morales-conde S, Peeters A, Meyer Y M, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery [J]. Surgical endoscopy, 2019, 33(4): 996-1019.

[11] Gu C, Wu Q, Zhang X, et al. Single-incision versus conventional multiport laparoscopic surgery for colorectal cancer: a meta-analysis of randomized controlled trials and propensity-score matched studies [J]. International journal of colorectal disease, 2021, 36(7): 1407-19.

[12] Hoyuela C, Juvany M, Carvajal F. Single-incision laparoscopy versus standard laparoscopy for colorectal surgery: A systematic review and meta-analysis [J]. American journal of surgery, 2017, 214(1): 127-40.

[13] Tei M, Sueda T, Matsumura T, et al. Systematic review of single-port vs. multi-port surgery for rectal cancer [J]. Molecular and clinical oncology, 2021, 14(2): 24.

[14] Liu X, Li J B, Shi G, et al. Systematic review of single-incision versus conventional multiport laparoscopic surgery for sigmoid colon and rectal cancer [J]. World journal of surgical oncology, 2018, 16(1): 220.

[15] Moher D, Liberatia, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement [J]. BMJ (Clinical research ed), 2009, 339: b2535.

[16] Cumpston M, Li T, Page M J, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions [J]. The Cochrane database of systematic reviews, 2019, 10: Ed000142.

[17] Hozo S P, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample [J]. BMC medical research methodology, 2005, 5: 13.

[18] Bulut O, Aslak K K, Levick, et al. A randomized pilot study on single-port versus conventional laparoscopic rectal surgery: effects on postoperative pain and the stress response to surgery [J]. Techniques in coloproctology, 2015, 19(1): 11-22.

[19] Huscher C G, Mingoli A, Sgarzini G, et al. Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study [J]. American journal of surgery, 2012, 204(1): 115-20.

[20] Kang B M, Park S J, Lee K Y, et al. Single-Port Laparoscopic Surgery Can Be Performed Safely and Appropriately for Colon Cancer: Short-Term Results of a Pilot Randomized Controlled Trial [J]. Journal of laparoendoscopic & advanced surgical techniques Part A, 2017, 27(5): 501-9.

[21] Poon J T, Cheung C W, Fan J K, et al. Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial [J]. Surgical endoscopy, 2012, 26(10): 2729-34.

[22] Takemasa I, Uemura M, Nishimura J, et al. Feasibility of single-site laparoscopic colectomy with complete mesocolic excision for colon cancer: a prospective case-control comparison [J]. Surgical endoscopy, 2014, 28(4): 1110-8.

[23] Velthuis S, Van Den Boezem P B, Lips D J, et al. Comparison of short-term surgical outcomes after single-incision laparoscopic versus multiport laparoscopic right colectomy: a two-center, prospective case-controlled study of 100 patients [J]. Digestive surgery, 2012, 29(6): 477-83.

[24] Watanabe J, Ota M, Fujii S, et al. Randomized clinical trial of single-incision versus multiport laparoscopic colectomy [J]. The British journal of surgery, 2016, 103(10): 1276-81.

[25] Lee Y S, Kim J H, Kim H J, et al. Short-term Outcomes of Single-port Versus Multiport Laparoscopic Surgery for Colon Cancer: The SIMPLE Multicenter Randomized Clinical Trial [J]. Annals of surgery, 2021, 273(2): 217-23.

[26] Pelosi M A, Pelosi M A 3RD. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture [J]. New Jersey medicine: the journal of the Medical Society of New Jersey, 1991, 88(10): 721-6.

[27] Pelosi M A, Pelosi M A 3RD. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy) [J]. The Journal of reproductive medicine, 1992, 37(7): 588-94.

[28] Navarra G, Pozza E, Oocchionorelli S, et al. One-wound laparoscopic cholecystectomy [J]. The British journal of surgery, 1997, 84(5): 695.

[29] Katsuno G, Fukunaga M, Nagakari K, et al. Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases [J]. Surgical endoscopy, 2016, 30(4): 1317-25.

[30] Yun J A, Yun S H, Park Y A, et al. Oncologic Outcomes of Single-incision Laparoscopic Surgery Compared With Conventional Laparoscopy for Colon Cancer [J]. Annals of surgery, 2016, 263(5): 973-8.

[31] Kim C W, Cho M S, Baek S J, et al. Oncologic outcomes of single-incision versus conventional laparoscopic anterior resection for sigmoid colon cancer: a propensity-score matching analysis [J]. Annals of surgical oncology, 2015, 22(3): 924-30.

[32] Pucher P H, Sodergren M H, Singh P, et al. Have we learned from lessons of the past? A systematic review of training for single incision laparoscopic surgery [J]. Surgical endoscopy, 2013, 27(5): 1478-84.

[33] Brockhaus A C, Sauerland S, Saad S. Single-incision versus standard multi-incision laparoscopic colectomy in patients with malignant or benign colonic disease: a systematic review, meta-analysis and assessment of the evidence [J]. BMC surgery, 2016, 16(1): 71.

[34] Yang T X, Chua T C. Single-incision laparoscopic colectomy versus conventional multiport laparoscopic colectomy: a meta-analysis of comparative studies [J]. International journal of colorectal disease, 2013, 28(1): 89-101.

[35] Markar S R, Wiggins T, Penna M, et al. Single-incision versus conventional multiport laparoscopic colorectal surgery-systematic review and pooled analysis [J]. Journal of gastrointestinal surgery: official journal of the Society for Surgery of the Alimentary Tract, 2014, 18(12): 2214-27.

[36] Ragupathi M, Ramos-Valadez D I, Yaakovian M D, et al. Single-incision laparoscopic colectomy: a novel approach through a Pfannenstiel incision [J]. Techniques in coloproctology, 2011, 15(1): 61-5.

[37] Dapri G, Carandina S, Mathonet P, et al. Suprapubic single-incision laparoscopic right hemicolectomy with intracorporeal anastomosis [J]. Surgical innovation, 2013, 20(5): 484-92.

[38] Takeda A, Imoto S, Mori M, et al. Management of large adnexal tumors by isobaric laparoendoscopic single-site surgery with a wound retractor [J]. European journal of obstetrics, gynecology, and reproductive biology, 2013, 166(2): 185-9.

[39] Fader A N, Rojas-Espaillat L, ibeanu O, et al. Laparoendoscopic single-site surgery (LESS) in gynecology: a multi-institutional evaluation [J]. American journal of obstetrics and gynecology, 2010, 203(5): 501.e1-6.

[40] Hirano Y, Hattori M, Douden K, et al. Single-incision plus one port laparoscopic anterior resection for rectal cancer as a reduced port surgery [J]. Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2012, 101(4): 283-6.

[41] Podolsky E R, St John-Dillon L, King S A, et al. Reduced port surgery: an economical, ecological, educational, and efficient approach to development of single port access surgery [J]. Surgical technology international, 2010, 20: 41-6.

[42] Wang Y, Deng H, Mou T, et al. Short-term outcomes of single-incision plus one-port laparoscopic versus conventional laparoscopic surgery for rectosigmoid cancer: a randomized controlled trial [J]. Surgical endoscopy, 2019, 33(3): 840-8.

[43] Lee S W, Milsom J W, Nash G M. Single-incision versus multiport laparoscopic right and hand-assisted left colectomy: a case-matched comparison [J]. Diseases of the colon and rectum, 2011, 54(11): 1355-61.