Oncologic long-term outcome of single-incision laparoscopic surgery (SILS) for colorectal cancer.

PURPOSE

Single-incision laparoscopic surgery (SILS) has been introduced as a less invasive alternative to multi-port laparoscopic surgery (MLS). MLS is widely accepted for the treatment of colorectal cancer, but there remains minimal evidence for the use of SILS. Thus, we compared both short- and long-term outcomes of SILS and open surgery (OS) in matched cohorts of colorectal cancer patients.

METHODS

Some 910 patients had colorectal resections for cancer between 2006 and 2013, and 134 of them were operated on using SILS. Eighty of these SILS patients were compared to a cohort of patients who had open surgery that were matching in tumour stage and location, type of resection, sex, age and ASA Score. Disease-free survival at 5 years (5y-DFS) was the primary endpoint; morbidity and hospitalization were secondary parameters. The role of surgical training in SILS was also investigated.

RESULTS

Clavien Dindo ≥ IIIb complications occurred in 13.8% in both groups. 5y-DSF were 82% after SILS and 70% after OS (p = 0.11). Local recurrence after rectal cancer tended to be lower after SILS (0/43 (SILS) vs. 4/35 (OS), p = 0.117). Length of stay was significantly shorter after SILS (10 vs. 14 days, p = 0.0004). The rate of operations performed by surgical residents was equivalent in both groups (44/80 (SILS) vs. 46/80 (OS), p = 0.75).

CONCLUSION

The data demonstrates that SILS results in similar long-term oncological outcomes when compared to open surgery as well as morbidity rates. The hospital stay in the SILS group was shorter. SILS can also be incorporated in surgical training programmes.