Clinical Study Of Single-incision Laparoscopic Low Anterior Rectal Resection Via Ileostomy Site

Aim:Single-incision laparoscopic surgery(SILS)is a further development of minimally invasive surgery.It has been widely used in the treatment of colon cancer and upper rectal cancer,however,there are still fewer reports on its use in the treatment of low rectal cancer,especially in patients with low rectal cancer who need a protective stoma.The aim of this study was to compare the outcomes of single-incision laparoscopic low anterior rectal resection via ileostomy site with conventional laparoscopic surgery(CLS)and to explore the value of single-incision laparoscopic technique in low anterior rectal resection combined with ileostomy.Methods:This is a retrospective cohort study that included a total of 133 patients with low rectal cancer from January 2019 to November 2021 by the same attending surgeon at the Affiliated Hospital of North SiChuan Medical College,matched 1:2 by Propensity Score Matching(PSM),with matching variables of sex,age,diabetes,previous abdominal surgery,body mass index(BMI),American Society of Anesthesiologists(ASA)score,pathological stage,cytology type,neoadjuvant chemoradiation,preoperative obstruction,tumour distance from anal verge,and maximum diameter of tumor,.The two groups were evaluated for intraoperative and perioperative outcomes,pathological results,and short-term prognosis.Results:A total of 81 cases were included after matching,including 27 cases in the SILS group and 54 cases in the CLS group.The baseline characteristics were well balanced between SILS and CLS groups after matching,and the difference was not statistically significant.Both groups were successfully completed according to the Total Mesorectal Excision(TME)principle.No significant differences were seen between the two groups in terms of operative time,blood loss,intraoperative complications and conversion rate.The SILS group had fewer leukocyte alteration[3.36*109/L(3.565)vs 4.475*109/L(3.342),P=0.045],shorter time to first bowel sounds[19 h(9)vs 32 h(10),P<0.001]and first exhaust[31 h(10)vs 38h(8.2),P<0.001],less length of hospital stay[7 days(1.5)vs 8 days(2),P=0.004],and lower VAS on POD2(P=0.00012)and POD3(P=0.028),compared to the CLS group.The incidence of postoperative complications was 14.8%and 11.1%in the SILS and CLS groups,respectively,and the difference was not statistically significant(P=0.724).The readmission rate within 30 days after surgery was 7.4%in both groups,and there was no death within 30 days after surgery in either group.In terms of pathological outcomes,the two groups showed no difference in the number of harvested lymph nodes(P=0.989),qualified lymph node dissection(P=0.419),and the length of distal resection margin(P=0.891).However,the SILS group had fewer lymph node dissection in No.253[4(2.5):5(2),P=0.04].There were no positive cases of resection margin and circumferential resection margin in either group.The median follow-up time was 9 months and 24.5 months in the SILS and CLS groups,respectively.During the follow-up period,there was one case of local recurrence in the SILS group and two cases of local recurrence and one case of heterochronic liver metastasis in the CLS group.Conclusions:Single-port laparoscopic low anterior rectal resection via ileostomy site has the advantages of rapid postoperative recovery,less pain,and short hospital stay,as well as achieving radical tumor cure.It can be used as an alternative procedure for patients with low rectal cancer who have the need for a protective ileostomy.