Department of Surgical Oncology, Institut Gustave Roussy, Villejuif, France.
Dis Colon Rectum. 2013 Nov;56(11):1203-10. doi: 10.1007/DCR.12345678787890.
Rectal surgery via a single-port access is complex with unknown benefits.
This study aimed to compare the short-term outcome between single-port and multiport procedures.
We undertook a retrospective analysis of prospectively collected data in a large, tertiary care cancer center in France.
From November 2008 to June 2012, 45 patients underwent a sphincter-saving rectal resection through a single-port (n = 13) or a multiport (n = 32) approach. The single-port approach used an abdominal single port (n = 6) alone or a combined abdominal and transanal single port (n = 7).
This study analyzed the morbidity, mortality, pain, and quality of the oncologic resection.
The groups had a similar median operative time (290 vs 280 minutes, p = 0.54) and conversion rates (8% vs 6%, p = 0.90). No mortality occurred, and there was no difference in major morbidity (23% vs 16%, p = 0.50), anastomotic leakage (8% vs 9%, p = 1), or the length of the hospital stay (12 vs 14 days, p = 0.23). The median pain score was lower on postoperative day 2 in the single-port group (1.5 vs 4, p = 0.01). The 2 groups had similar quality criteria for oncologic resection, namely the median number of harvested lymph nodes (14 vs 15, p = 0.63), a good mesorectal dissection rate (85% vs 75%, p = 0.56), and positive resection margins (0% vs 6%, p = 0.10).
This study's limitations include the retrospective nature of the data and the small number of patients.
Rectal cancer surgery through a single-port access is feasible with similar outcomes and less postoperative pain than with multiport laparoscopy.
经单孔通道进行直肠手术较为复杂，且其益处尚不明确。
本研究旨在比较单孔与多孔手术的短期疗效。
我们对法国一家大型三级癌症治疗中心前瞻性收集的数据进行了回顾性分析。
2008 年 11 月至 2012 年 6 月，45 例患者接受了经肛门括约肌保留的直肠切除术，其中 13 例采用单孔（n=13），32 例采用多孔（n=32）入路。单孔入路中，6 例采用腹部单孔（n=6），7 例采用腹部联合经肛门单孔（n=7）。
本研究分析了发病率、死亡率、疼痛和肿瘤切除的质量。
两组的中位手术时间（290 分钟 vs 280 分钟，p=0.54）和中转率（8% vs 6%，p=0.90）相似。无死亡病例发生，两组主要发病率（23% vs 16%，p=0.50）、吻合口漏（8% vs 9%，p=1）或住院时间（12 天 vs 14 天，p=0.23）差异无统计学意义。单孔组术后第 2 天的中位疼痛评分（1.5 分 vs 4 分，p=0.01）较低。两组的肿瘤切除质量标准相似，即采集的淋巴结中位数（14 枚 vs 15 枚，p=0.63）、中高位直肠系膜的良好分离率（85% vs 75%，p=0.56）和阳性切缘率（0% vs 6%，p=0.10）。
本研究的局限性在于数据的回顾性和患者数量较少。
经单孔通道进行直肠癌手术是可行的，与多孔腹腔镜手术相比，术后疼痛较轻，且疗效相似。
