Kawamata Futoshi, Homma Shigenori, Minagawa Nozomi, Kawamura Hideki, Takahashi Norihiko, Taketomi Akinobu
Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan.
World J Surg. 2014 Oct;38(10):2716-23. doi: 10.1007/s00268-014-2642-8.
Reduced-port laparoscopic surgery is the latest innovation in minimally invasive surgery. We performed single-incision plus one additional port laparoscopy-assisted anterior resection (SILS + 1-AR) starting in August 2010. This study aimed at evaluating the feasibility of SILS + 1-AR and comparing it with that of conventional laparoscopy-assisted anterior resection (C-AR).
Patients with preoperative clinical stage 0 to stage III rectal cancer were included. Demographic, intraoperative, and pathological examination data, as well as short-term outcome data, of 20 patients who underwent SILS + 1-AR were retrospectively compared with that of 20 patients who underwent C-AR. Invasiveness of the two procedures was also evaluated through a vital signs diary and hematological examination on postoperative days (POD) 1, 3, and 7.
Operating time, mean estimated blood loss, the number of lymph nodes dissected, the number of lymph node metastases, and the mean distal resection margin length were not significantly different. However, postoperative neutrophil counts in the SILS + 1-AR group were lower than those in the C-AR group (P = 0.085). A significant difference in body temperature was observed in the SILS + 1-AR group on POD 1 (P = 0.028). No significant differences were observed in perioperative and overall morbidity between the two groups. Conversion to open surgery was required in 2 (10 %) of the 20 patients in the SILS + 1-AR group. The mean postoperative length of stay and recurrence rates were similar in the two groups.
SILS + 1-AR for rectal cancer is similar to C-AR in safety, feasibility, and provision of oncological radicality.
减孔腹腔镜手术是微创手术的最新创新技术。我们自2010年8月起开展单孔加一个辅助端口腹腔镜辅助前切除术（SILS + 1-AR）。本研究旨在评估SILS + 1-AR的可行性，并将其与传统腹腔镜辅助前切除术（C-AR）进行比较。
纳入术前临床分期为0至III期的直肠癌患者。对20例行SILS + 1-AR患者的人口统计学、术中及病理检查数据以及短期结局数据，与20例行C-AR患者的数据进行回顾性比较。还通过术后第1、3和7天的生命体征记录和血液学检查评估两种手术的侵袭性。
手术时间、平均估计失血量、清扫淋巴结数目、淋巴结转移数目及平均远端切缘长度无显著差异。然而，SILS + 1-AR组术后中性粒细胞计数低于C-AR组（P = 0.085）。SILS + 1-AR组术后第1天体温有显著差异（P = 0.028）。两组围手术期及总体发病率无显著差异。SILS + 1-AR组20例患者中有2例（10%）需要转为开放手术。两组术后平均住院时间和复发率相似。
直肠癌的SILS + 1-AR在安全性、可行性及肿瘤根治性方面与C-AR相似。
