Liu Ruoyan, Wang Yanan, Xiong Wenjun, Zhang Ze, Deng Haijun, Li Guoxin
Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Jun;19(6):647-53.
To evaluate the efficacy and cosmetic result of suprapubic single incision laparoscopic surgery(SSILS) in the treatment of rectosigmoid cancer.
Clinicopathological data of 16 patients undergoing SSILS and 122 undergoing conventional laparoscopic surgery(CLS) for sigmoid colon and upper rectal cancer in the Nanfang Hospital from August 2011 to July 2012 were retrospectively analyzed. The patients were analyzed with propensity score matching at a ratio of 1 to 2 by logistic regression analysis. The matching covariates included age, gender, body mass index, American Society of Anesthesiologists(ASA) score, tumor location, tumor diameter, pathologic TNM stage, previous abdominal surgery. After matching, 48 patients (16 SSILS and 32 CLS) were enrolled in the study. The SSILS group comprised of 13 (81.3%) males with mean age of (56.4±13.4) years. The CLS group comprised of 23(71.9%) males with mean age of (55.6±13.7) years. Postoperative short-term parameters, oncologic efficacy and cosmetic result were compared between the two groups.
The male gender ratio, age, body mass index, ASA score, tumor location, tumor diameter, tumor differentiation, depth of invasion, lymph node metastasis, TNM stage, previous abdominal surgery were comparable between the two groups. As compared to CLS group, less incision length [(4.8±1.5) cm vs. (6.8±1.2) cm, U=63.000, P=0.000], shorter time to ambulation [(2.6±1.0) days vs. (3.9±1.5) days, U=116.500, P=0.002], shorter hospital stay [(8.4±5.3) days vs.(9.2±3.1) days, U=139.000, P=0.010] and less postopertive pain(Visual Analogue Scale: 4.3±1.4 vs. 5.2±1.1 at day 3, t=2.457, P=0.018; 3.7±1.0 vs. 4.6±1.0 at day 4, t=2.700, P=0.010; 3.3±0.8 vs. 4.0±1.0 at day 5, t=2.466, P=0.017) were observed in SSILS group. The other short-term parameters(blood loss, operative time, insertion of additional port rate, time to flatus, defecation, time to liquid and soft diet, complication morbidity, number of lymph nodes harvested, proximal and distal resection margin) were not significantly different between 2 groups(all P>0.05). The median follow-up time was 41(22-49) months. There was no loco-regional recurrence in 2 groups. Distant metastasis was 18.8% (n=3, all liver metastasis) and 6.3% (n=2, one liver metastasis and one peritoneal metastasis) in SSILS and CLS groups (χ(2)=0.698, P=0.404) respectively. Three-year disease-free survival and 3-year overall survival were 81.3% vs 93.0%(χ(2)=1.355, P=0.244) and 100.0% vs 96.9%(χ(2)=0.500, P=0.480) in SSILS and CLS groups, respectively. Photograph questionnaire investigation showed that the cosmetic score was significantly higher in SSILS group than that in CLS group (8.9±1.1 vs. 7.6±1.1, U=100.500, P=0.000). Of 48 patients of 2 groups, 81.3%(39/48) case preferred SSILS.
In experienced laparoscopic treatment centers, SSILS for rectosigmoid cancer is feasible and safe with quite good oncological efficacy and certain advantages, such as fast recovery, less pain and better cosmetic result.
评估耻骨上单切口腹腔镜手术（SSILS）治疗直肠乙状结肠癌的疗效及美容效果。
回顾性分析2011年8月至2012年7月在南方医院接受SSILS治疗的16例患者及接受传统腹腔镜手术（CLS）治疗的122例乙状结肠和上段直肠癌患者的临床病理资料。通过逻辑回归分析按1:2的比例进行倾向评分匹配。匹配的协变量包括年龄、性别、体重指数、美国麻醉医师协会（ASA）评分、肿瘤位置、肿瘤直径、病理TNM分期、既往腹部手术史。匹配后，48例患者（16例SSILS和32例CLS）纳入研究。SSILS组有13例（81.3%）男性，平均年龄（56.4±13.4）岁。CLS组有23例（71.9%）男性，平均年龄（55.6±13.7）岁。比较两组术后短期参数、肿瘤学疗效及美容效果。
两组间男性性别比例、年龄、体重指数、ASA评分、肿瘤位置、肿瘤直径、肿瘤分化程度、浸润深度、淋巴结转移、TNM分期、既往腹部手术史具有可比性。与CLS组相比，SSILS组切口长度更短[（4.8±1.5）cm对（6.8±1.2）cm，U = 63.000，P = 0.000]，下床活动时间更短[（2.6±1.0）天对（3.9±1.5）天，U = 116.500，P = 0.002]，住院时间更短[（8.4±5.3）天对（9.2±3.1）天，U = 139.000，P = 0.010]，术后疼痛更轻（视觉模拟评分：术后第3天4.3±1.4对5.2±1.1，t = 2.457，P = 0.018；术后第4天3.7±1.0对4.6±1.0，t = 2.700，P = 0.010；术后第5天3.3±0.8对4.0±1.0，t = 2.466，P = 0.017）。其他短期参数（失血量、手术时间、额外端口置入率、排气时间、排便时间、进流食和软食时间、并发症发生率、清扫淋巴结数目、切缘近端和远端）两组间无显著差异（均P>0.05）。中位随访时间为41（22 - 49）个月。两组均无局部区域复发。SSILS组和CLS组远处转移率分别为18.8%（n = 3，均为肝转移）和6.3%（n = 2，1例肝转移和1例腹膜转移）（χ² = 0.698，P = 0.404）。SSILS组和CLS组的3年无病生存率分别为81.3%对93.0%（χ² = 1.355，P = 0.244），3年总生存率分别为100.0%对96.9%（χ² = 0.500，P = 0.480）。照片问卷调查显示，SSILS组美容评分显著高于CLS组（8.9±1.1对7.6±1.1，U = 100.500，P = 0.000）。两组48例患者中，81.3%（39/48）的病例更喜欢SSILS。
在有经验的腹腔镜治疗中心，SSILS治疗直肠乙状结肠癌是可行且安全的，具有良好的肿瘤学疗效及某些优势，如恢复快、疼痛轻和美容效果好。
