Lim Sang Woo, Kim Hyeong Rok, Kim Young Jin
Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, Gwangju, Korea.
Ann Surg Treat Res. 2014 Sep;87(3):131-8. doi: 10.4174/astr.2014.87.3.131. Epub 2014 Aug 26.
The aim of this retrospective study was to evaluate the feasibility of single incision laparoscopic surgery (SILS), and to compare the short-term surgical outcomes with those of conventional laparoscopic surgery for colorectal cancer.
Forty-four patients who underwent SILS were compared with 263 patients who underwent conventional laparoscopic surgery for colorectal adenocarcinoma between November 2011 and September 2012.
In the SILS group, eleven cases (25.0%) of right hemicolectomy, 15 (34.1%) anterior resections, and 18 (40.9%) low anterior resections were performed. Additional ports were required in 10 rectal patients during SILS operation. In the 32 patients with rectosigmoid and rectal cancer in the SILS group, patients with mid and lower rectal cancers had a tendency to require a longer operation time (168.2 minutes vs. 223.8 minutes, P = 0.002), additional ports or multiport conversion (P = 0.007), than those with rectosigmoid and upper rectal cancer. Both SILS and conventional groups had similar perioperative outcomes. Operation time was longer in the SILS group than in the conventional laparoscopic surgery group (185.0 minutes vs. 139.2 minutes, P < 0.001). More diverting stoma were performed in the SILS group (64.7% vs. 24.2%, P = 0.011). Multivariate analysis showed that tumor location in the rectum (95% confidence interval [CI], 1.858-10.560; P = 0.001), SILS (95% CI, 3.450-20.233; P < 0.001), diverting stoma (95% CI, 1.606-9.288; P = 0.003), and transfusion (95% CI, 1.092-7.854; P = 0.033) were independent risk factors for long operation time (>180 minutes).
SILS is a feasible, not inferior treatment option for colorectal cancer, and appears to have similar results as standard conventional multiport laparoscopic colectomy, despite the longer operative time.
本回顾性研究旨在评估单孔腹腔镜手术（SILS）的可行性，并比较其与传统腹腔镜手术治疗结直肠癌的短期手术效果。
将2011年11月至2012年9月期间接受SILS的44例患者与接受传统腹腔镜手术治疗结直肠癌的263例患者进行比较。
在SILS组中，进行了11例（25.0%）右半结肠切除术、15例（34.1%）前切除术和18例（40.9%）低位前切除术。10例直肠患者在SILS手术期间需要额外增加端口。在SILS组的32例直肠乙状结肠和直肠癌患者中，直肠中下段癌患者的手术时间往往更长（168.2分钟对223.8分钟，P = 0.002），需要额外增加端口或转为多端口手术的比例更高（P = 0.007），高于直肠乙状结肠和上段直肠癌患者。SILS组和传统组的围手术期结果相似。SILS组的手术时间比传统腹腔镜手术组长（185.0分钟对139.2分钟，P < 0.001）。SILS组进行造口转流术的比例更高（64.7%对24.2%，P = 0.011）。多因素分析显示，直肠肿瘤位置（95%置信区间[CI]，1.858 - 10.560；P = 0.001）、SILS（95% CI，3.450 - 20.233；P < 0.001）、造口转流术（95% CI，1.606 - 9.288；P = 0.003）和输血（95% CI，1.092 - 7.854；P = 0.033）是手术时间长（>180分钟）的独立危险因素。
SILS是一种可行的结直肠癌治疗选择，并不逊色，尽管手术时间较长，但似乎与标准的传统多端口腹腔镜结肠切除术效果相似。
