Hata Taishi, Kawai Kenji, Naito Atsushi, Kagawa Yoshinori, Kitahara Tomohiro, Hiraki Masayuki, Shinke Go, Katsuyama Shinsuke, Katsura Yoshiteru, Ohmura Yoshiaki, Masuzawa Toru, Takeno Atsushi, Takeda Yutaka, Kato Takeshi, Murata Kohei
Department of Gastroenterological Surgery, Kansai Rosai Hospital, Amagasaki, Japan.
Department of Gastroenterological Surgery, Osaka Police Hospital, Osaka, Japan.
Eur Surg Res. 2022;63(4):196-202. doi: 10.1159/000520677. Epub 2021 Nov 5.
There are little data concerning the long-term outcome of single-incision laparoscopic surgery (SILS) for colon cancer. Therefore, we investigated not only the short-term outcomes but also the long-term outcomes of SILS for right-side colon cancer.
We retrospectively compared short- and long-term outcomes of SILS and conventional laparoscopic surgery (CLS) for right-sided colon cancer in our institution. Intergroup differences of short-term outcomes were evaluated using χ2 or Fisher exact tests and 2-sample Student t tests. The disease-free survival rates (long-term outcome) of stage II and III patients were estimated using the Kaplan-Meier method and compared using log-rank tests.
There were 290 operations conducted for right-side (cecum and ascending) colorectal cancers from April 2011 to July 2018. Open surgery was performed in 12 cases from start to the operation. SILS was performed in 196 cases and CLS in 55 cases. One patient underwent intraoperative conversion from SILS to laparotomy for bleeding control. In addition, 1 port was added to SILS in 3 cases. These 4 cases were included in the analysis as the SILS group according to the principle of intent to treat.
Factors including age, gender, body mass index, performance status, and tumor stage were not statistically different between the SILS and CLS groups. In short-term outcomes, the number of harvested lymph nodes was not statistically different. SILS required less operating time (p < 0.001) and resulted in a reduced bleeding volume (p < 0.001). There was no statistical difference in the frequency of overall complications (p = 0.06). The disease-free survival of stage II and III patients was not statistically different between the 2 groups.
With the proper adaptation of SILS by an experienced surgeon, the short- and long-term outcomes of SILS were not inferior to those of CLS. Therefore, SILS could be a treatment option for right-sided colon cancer.
关于单孔腹腔镜手术（SILS）治疗结肠癌的长期预后的数据较少。因此，我们不仅研究了SILS治疗右侧结肠癌的短期预后，还研究了其长期预后。
我们回顾性比较了本院SILS和传统腹腔镜手术（CLS）治疗右侧结肠癌的短期和长期预后。短期预后的组间差异采用χ2检验或Fisher精确检验以及两样本t检验进行评估。采用Kaplan-Meier法估计II期和III期患者的无病生存率（长期预后），并采用对数秩检验进行比较。
2011年4月至2018年7月期间，共进行了290例右侧（盲肠和升结肠）结直肠癌手术。从开始到手术，12例进行了开放手术。196例进行了SILS，55例进行了CLS。1例患者因术中出血控制从SILS转为开腹手术。此外，3例SILS手术中增加了1个端口。根据意向性治疗原则，这4例患者被纳入SILS组进行分析。
SILS组和CLS组在年龄、性别、体重指数、体能状态和肿瘤分期等因素上无统计学差异。在短期预后方面，清扫淋巴结数量无统计学差异。SILS所需手术时间更短（p < 0.001），出血量减少（p < 0.001）。总体并发症发生率无统计学差异（p = 0.06）。两组II期和III期患者的无病生存率无统计学差异。
经验丰富的外科医生适当采用SILS，其短期和长期预后并不逊于CLS。因此，SILS可作为右侧结肠癌的一种治疗选择。
