Background

To evaluate the clinical and oncological outcomes of single-incision laparoscopic surgery (SILS) vs. conventional laparoscopic surgery (CLS) for patients with rectal cancer (RC) who underwent total mesorectal excision (TME) surgery.

Methods

This was a retrospective case–control study of patients with RC operated between 12/2013 and 12/2017 in Ruijin Hospital North, Shanghai Jiaotong University School of Medicine. In total, 177 patients who underwent CLS and 51 who underwent SILS met the inclusion and exclusion criteria and were matched 1:1 using propensity score matching method (PSM).

Results

Compared with the CLS group, the SILS group showed shorter operation time [105 (40) vs. 125 (55) min, P = 0.045], shorter total incision length [4 (1) vs. 6.5 (1.5) cm, P < 0.001], lower VAS score on POD2 [1 (1) vs. 2 (1), P < 0.001], shorter time to soft diet [7 (1) vs. 8 (2) days, P = 0.048], and shorter length of hospital stay [9 (2) vs. 11 (3) days, P < 0.001]. The postoperative complications were similar between two groups [1(2%) vs. 5 (9.8%), P = 0.205]. No readmissions or mortality in either group occurred within 30 days of surgery. All 102 specimens met the requirements of TME. No significant differences were observed in the pathologic outcomes between the two groups. The median follow-up period was 32.6 months in the SILS group and 36.8 months in the CLS group (P = 0.053). The 3-year disease-free survival rates and overall survival rates of the SILS and CLS groups were 89.8% vs. 96.0% (P = 0.224) and 90.9% vs. 96.9% (P = 0.146), respectively.

Conclusions

Compared with CLS, TME surgery for rectal cancer can be performed safely and effectively using the SILS technique with better cosmetic results, less postoperative pain, faster postoperative recovery, and acceptable clinical and oncological outcomes.

中文翻译：

---

单切口与常规腹腔镜手术治疗直肠癌的临床和肿瘤学结局。

背景

为了评估接受全直肠系膜切除术（TME）的直肠癌（RC）患者，单切口腹腔镜手术（SILS）与常规腹腔镜手术（CLS）的临床和肿瘤学结局。

方法

这是对上海交通大学医学院附属瑞金医院北于12/2013至12/2017期间手术的RC患者的回顾性病例对照研究。共有177例行CLS的患者和51例行SILS的患者符合纳入和排除标准，并使用倾向评分匹配法（PSM）进行了1：1匹配。

结果

与CLS组相比，SILS组的手术时间较短[105（40）vs. 125（55）min，P  = 0.045]，总切口长度较短[4（1）vs. 6.5（1.5）cm，P  < 0.001]，POD2的VAS评分较低[1（1）vs. 2（1），P  <0.001]，软饮食时间较短[7（1）vs. 8（2）天，P  = 0.048]，并且较短住院时间[9（2）vs. 11（3）天，P  <0.001]。两组术后并发症相似[1（2％）vs. 5（9.8％），P = 0.205]。两组在手术后30天内均未发生再入院或死亡。全部102个标本均符合TME的要求。两组之间的病理结果均未见明显差异。SILS组的中位随访期为32.6个月，CLS组的中位随访期为36.8个月（P  = 0.053）。SILS和CLS组的3年无病生存率和总生存率分别为89.8％和96.0％（P  = 0.224）和90.9％和96.9％（P  = 0.146）。

结论

与CLS相比，使用SILS技术可以安全有效地进行TME直肠癌手术，具有更好的美容效果，更少的术后疼痛，更快的术后恢复以及可接受的临床和肿瘤学结果。