Meta-analysis Of Single-incision Laparoscopy In Colorectal Cancer Surgery And Its Clinical Value

Background:With the development and progress of society and the improvement of people’s living conditions,people’s pursuit of minimally invasive effect is also constantly improving,and the demand for cosmetic effect of incision,even no abdominal incision is increasingly fierce.At present,Conventional Multiport Laparoscopic Surgical(CMLS)has been unable to satisfy the majority of patients.In this context,Natural Orifice Transluminal Endoscopic Surgery(NOTES[1])emerged at the moment.However,due to the difficulties of NOTES in sterility,tumor-free,ethics,natural cavity incision closure,and operation techniques,this minimally invasive technique cannot be widely carried out in clinical practice.This led to another intermediary,single-incision laparoscopic Surgery(SILS[2]),which involves performing all surgical procedures using a small incision in the abdomen,perfectly hidden by a natural barrier called the navel.It can also achieve "scar free" abdominal surgery.It can also reduce surgical trauma,speed up postoperative recovery,and abandon the shortcomings of NOTES,so it is favored by most surgeons and also accepted by the majority of patients,achieving a "win-win" situation.Objective:The differences between single-incision laparoscopic surgery(SILS)and porous laparoscopic surgery(CMLS)in colorectal cancer surgery were evaluated by literature retrieval,so as to explore the advantages and clinical application value of SILS in colorectal cancer surgery,and provide data support for the development and application of this technology.Methods:A computer search was conducted to compare the results of single-incision laparoscopy and Conventional Multiport Laparoscopic Surgical in colorectal cancer surgery published in Pubmed,Embase,Cochrane Library,CNKI,Wanfang,Chinese Biomedical Literature Database,VIP and other Chinese and English databases.After the inclusion,exclusion criteria and quality evaluation,the required research data were obtained from the final included literature,and Stata(version 14.0)was used for statistical analysis of the data.Results:A total of 20 Randomized Controlled trials(RCTS)were included,involving a total of 2215 patients,including 1109 patients in the SILS group and 1106 patients in the CMLS group.Meta-analysis results showed that:In the SILS group and CMLS group,the length of hospital stay[WMD=-0.372,95%CI(-0.638～-0.106),P=0.006<0.05],the time of first postoperative exhaust[WMD=-0.38,95%CI(-0.577～-0.183),P=0<0.05],first postoperative defecation time[WMD=-0.355,95%CI(-0.668～-0.041),P=0.027<0.05],incision length[WMD=-2.574,95%CI(-3.087～-2.060),P=0<0.05],the distance between the proximal resection margin and the tumor edge[WMD=0.783,95%CI(0.596-0.970),P=0<0.05],postoperative pain sensation[WMD=-1.173,95%CI(-1.430～-0.916),P=0<0.05]and total postoperative complications[RR=0.774,95%CI(0.630～0.951),P=0.015<0.05].The related data of SILS group were better than that of CMLS group,while the operative time of the two groups[WMD=6.758,95%CI(-3.373～16.889),P=0.191>0.05),amount of blood loss[WMD=-9.467,95%CI(-20.585～1.651),P=0.095>0.05],number of dissected lymph nodes[WMD=0.033,95%CI(-0.261～0.327),P=0.826>0.05),distance between distal resection margin and tumor margin[WMD=-0.103,95%CI(-0.453～0.247),P=0.564>0.05],one-year postoperative follow-up survival rate[RR=0.8,95%CI(0.394～1.626),P=0.537>0.05)showed nostatistical significance.Conclusion:This paper conducted a meta-analysis based on the results of 20 RCTS.Conclusion:Single-incision laparoscopic technique is safe,reliable and feasible in colorectal cancer surgery.The short-term efficacy advantages of single-incision laparoscopic technology are mainly reflected in:small surgical incision,short hospital stay,light postoperative pain,quick postoperative recovery,etc.As for the long-term efficacy of single-incision laparoscopy,there is still a lack of research reports at domestic and abroad,which requires further clinical exploration in abdominal surgery.