Department of General, Visceral and Transplant Surgery, University Medicine of Johannes Gutenberg-University, Langenbeckstr 1, 55131, Mainz, Germany.
Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
Int J Colorectal Dis. 2021 Aug;36(8):1751-1758. doi: 10.1007/s00384-021-03902-0. Epub 2021 Mar 16.
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.
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.
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).
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.
单切口腹腔镜手术（SILS）作为一种微创替代方法，已被引入多端口腹腔镜手术（MLS）。MLS 广泛应用于结直肠癌的治疗，但 SILS 的应用证据有限。因此，我们比较了结直肠癌患者的 SILS 和开放性手术（OS）的短期和长期结果。
2006 年至 2013 年间，共有 910 例患者接受了结直肠切除术治疗癌症，其中 134 例采用 SILS 进行手术。在肿瘤分期和位置、手术类型、性别、年龄和 ASA 评分相匹配的情况下，对其中 80 例 SILS 患者与接受开放性手术的患者进行了比较。5 年无病生存率（5y-DFS）是主要终点；发病率和住院时间是次要参数。还研究了手术培训在 SILS 中的作用。
两组均有 13.8%的患者发生 Clavien Dindo ≥ IIIb 级并发症。SILS 后 5y-DFS 为 82%，OS 后为 70%（p=0.11）。直肠肿瘤患者 SILS 后局部复发率较低（0/43（SILS）与 4/35（OS），p=0.117）。SILS 后住院时间明显缩短（10 天 vs. 14 天，p=0.0004）。两组中接受手术住院医师手术的比例相当（SILS 为 44/80（SILS），OS 为 46/80（OS），p=0.75）。
数据表明，与开放性手术相比，SILS 的长期肿瘤学结果相似，且发病率相当。SILS 组的住院时间更短。SILS 也可以纳入手术培训计划。
