Choi Byung Jo, Jeong Won Jun, Kim Say-June, Lee Sang Chul
Department of Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
Medicine (Baltimore). 2017 Jul;96(28):e6649. doi: 10.1097/MD.0000000000006649.
Single-port laparoscopic surgery (SPLS) is being increasingly performed for treating colorectal cancer. Here, we aimed to assess the safety and feasibility of SPLS for colorectal cancer in obese patients through a comparison of their short-term outcomes with those of nonobese patients.A total of 323 patients who underwent SPLS for colorectal cancer at our center between March 2009 and August 2014 were enrolled. The outcomes were analyzed according to the body mass index (BMI) category: nonobese (BMI < 25), obese I (BMI: 25.0-29.9), and obese II (BMI ≥ 30).Of the 323 patients, 233 (72.1%), 80 (24.8%), and 10 (3.1%), were assigned to the nonobese, obese I, and obese II groups, respectively. The clinicopathologic patient characteristics, such as age, gender, tumor location, and previous laparotomy, were similar among the 3 groups. The mean operative time (nonobese vs obese I vs and obese II groups: 269.2 vs 270.4 vs 342.8 minutes, respectively) and estimated surgical blood loss (277.7 vs 260.5 vs 387.0 mL, respectively) were greater in the obese II group than in the nonobese and obese I groups, although the difference was not significant (P = .247 and P = .205, respectively). However, the time to passage of flatus significantly differed among the groups (P = .040); in particular, this value was significantly longer in the obese II group than in the obese I group (P = .031). None of the other parameters, including conversion to open or conventional laparoscopic surgery and intra- and postoperative morbidity, significantly differed among the 3 groups.SPLS for colorectal cancer can be safely performed in obese Asian patients with equivalent short-term outcomes as compared with that in nonobese patients. Hence, SPLS can be safely recommended for colorectal cancer in obese patients if the surgeon is experienced. Nevertheless, the technique used warrants further investigation, and a large-scale prospective study is required.
单孔腹腔镜手术（SPLS）越来越多地用于治疗结直肠癌。在此，我们旨在通过比较肥胖患者与非肥胖患者的短期结局，评估SPLS治疗肥胖患者结直肠癌的安全性和可行性。
2009年3月至2014年8月期间，共有323例在本中心接受SPLS治疗结直肠癌的患者入组。根据体重指数（BMI）类别分析结局：非肥胖（BMI < 25）、肥胖I（BMI：25.0 - 29.9）和肥胖II（BMI≥30）。
323例患者中，分别有233例（72.1%）、80例（24.8%）和10例（3.1%）被分配到非肥胖组、肥胖I组和肥胖II组。3组患者的临床病理特征，如年龄、性别、肿瘤位置和既往剖腹手术史，相似。肥胖II组的平均手术时间（非肥胖组vs肥胖I组vs肥胖II组：分别为269.2分钟、270.4分钟和342.8分钟）和估计手术失血量（分别为277.7毫升、260.5毫升和387.0毫升）虽高于非肥胖组和肥胖I组，但差异无统计学意义（P分别为0.247和0.205）。然而，各组之间的排气时间有显著差异（P = 0.040）；特别是，肥胖II组的该值显著长于肥胖I组（P = 0.031）。其他参数，包括转为开放或传统腹腔镜手术以及术中和术后发病率，在3组之间均无显著差异。
与非肥胖患者相比，肥胖亚洲患者行SPLS治疗结直肠癌的短期结局相当，且可以安全进行。因此，如果外科医生经验丰富，SPLS可安全推荐用于肥胖患者的结直肠癌治疗。尽管如此，所采用的技术仍需进一步研究，并且需要进行大规模的前瞻性研究。
