Clinical Study Of Single-Incision Laparoscopic Radical Resection For Sigmoid Colon And Upper Rectal Cancer

Part I: Short-term and Long-term Outcomes of SingleIncision Laparoscopic Radical Resection for Sigmoid Colon nd Upper Rectal Cancer Objective:The aim of the study was to analyze the short-term safety and effectiveness,potential benefits and long-term outcomes to evaluate the value of single-incision laparoscopic surgery(SILS)compared to multi-port laparoscopic surgery(MLS)for sigmoid colon and upper rectal cancer.Methods:From December 2013 to September 2018,410 patients underwent laparoscopic radical resection for sigmoid colon and upper rectal cancer through a SILS(n=83)and a MLS(n=327)approach by the same surgical team led by the same senior surgeon in Ruijin Hospital and Ruijin Hospital North,Shanghai Jiaotong University School of Medicine in China.The patients were matched at a ratio of 1:1 according to age,sex,BMI,previous abdominal surgeries,comorbidities,ASA grade,and pathologic stage using propensity score matching(PSM)analysis.The data of intraoperative and perioperative period,pathological outcomes and long-term prognosis were prospectively collected and retrospectively analyzed and compared.Results:After PSM,no significant differences were observed in baseline characteristics between the SILS and MLS groups.In terms of intraoperative and perioperative indicators,there were no significant differences in intraoperative blood loss,intraoperative complications,surgical conversion,postoperative diet recovery,length of postoperative hospital stay and postoperative complications.The operation time in the SILS group(114.55±35.00 min)was longer than that in the MLS group(106.22 39.24min)(p=0.018).The SILS group showed smaller incision length(4.27±1.41 cm vs 6.83±1.79 cm,p < 0.001)and lower VAS score on the day of operation(3.93±1.18 vs 4.42±1.30,p=0.008)than the MLS group.One patient in the MLS group underwent reoperation the day after surgery due to bleeding of IMA,and no mortality or readmission occurred within 30 days after surgery in either group.The pathologic outcomes were similar between two groups.The median follow-up period was 25.1 months in the SILS group and 29.1 months in the MLS group(p = 0.086).Each of the two groups included 3 recurrences(3.6%).The 3-year DFS were 92.0% and 93.1%(p = 0.781),and 3-year OS were 91.1% and 95.6%(p = 0.536)in the SILS and the MLS groups,respectively.No incisional hernia was observed during the follow-up period in either group.Conclusion:Though the operation time was longer in the SILS group in the present study,the short-term and long-term outcomes were similar,the incision length was smaller and the VAS score on the day of operation was lower compared with the MLS group.Thus,the single-incision laparoscopic radical resection for sigmoid colon and upper rectal cancer is safe,feasible,effective and has the advantages of reducing postoperative pain and good cosmetic effect.It has the value of application and popularization.Part Ⅱ: Learning Curve of the Single-Incision Laparoscopic adical Resection for Sigmoid Colon and Upper Cancer Objective:To analyze the learning curve(LC)of the single-incision laparoscopic radical resection for sigmoid colon and upper rectal cancer and provide reference for the surgeons to learn the technology.Methods:Data of 83 consecutive patients who underwent SILS for sigmoid colon and upper rectal cancer from December 2013 to September 2018 by the same senior surgeon was prospectively collected and retrospectively analyzed.The LC of SILS for sigmoid colon and upper rectal cancer was evaluated using cumulative summation(CUSUM)and moving average methods.The learning process was further compared in phases according to the LC.Results:The LC of SILS for sigmoid colon and upper rectal cancer was divided into three phases,namely the novice stage(Stage I,1-11 cases),the plateau stage(Stage II,12-53 cases)and the proficiency stage(Stage III,54-83 cases).The baseline characteristics were comparable among the three stages.There were significant differences among the three stages in terms of operation time(p=0.021),time to semi-liquid diet(p=0.011)and time to remove abdominal drainage tube(p<0.001),among which the Stage III was the shortest.No significant difference in intraoperative blood loss,surgical conversion,postoperative complications and pathological outcomes were observed among the three stages.Conclusion:The LC of SILS for sigmoid colon and upper rectal cancer consisted of three phases.The plateau stage was reached after about 11 cases.53 cases were needed to overcome the LC.