Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: results of a 190-patient, 7-criterion case-match study

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• 作者：John H. Marks ; Grace A. Montenegro ; Margaret V. Shields…
• 关键词：Laparoscopy ; Single ; port surgery ; Minimally invasive surgery ; Colorectal surgery
• 刊名：Surgical Endoscopy
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：29
• 期：6
• 页码：1492-1499
• 全文大小：412 KB
• 参考文献：1.Braga M et al (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short outcome. Ann Surg 236:759-66View Article PubMed Central PubMed
  2.Bonjer HJ et al (2007) Laparoscopically assisted vs. open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298-03View Article PubMed
  3.Delaney CP et al (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819-24View Article PubMed
  4.Kuhry E et al (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a Cochrane systematic review of randomized control trials. Cancer Treat Rev 34:498-04View Article PubMed
  5.Lourenco T et al (2008) Laparoscopic surgery for colorectal cancer: safe and effective? A systematic review. Surg Endosc 22:1146-160View Article PubMed
  6.Huang MJ et al (2011) Laparoscopic-assisted versus open surgery for rectal cancer: a meta-analysis of randomized control trials on oncologic adequacy of resection and long-term oncologic outcomes. Int J Colorectal Dis 26:415-21View Article PubMed
  7.Braga M et al (2011) Long-term outcomes after laparoscopic colectomy. World J Gastrointest Oncol 15:43-8
  8.Papaconstantinou HT, Thomas JS (2011) Single-incision laparoscopic colectomy for cancer: assessment of oncologic resection and short-term outcomes in a case-matched comparison with standard laparoscopy. Surgery 150:820-27View Article PubMed
  9.Huscher CG, Mingoli A, Sgarzini G et al (2011) Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. Am J Surg 204:115-20View Article PubMed
  10.Waters JA et al (2010) Single-port laparoscopic right hemicolectomy: a safe alternative to conventional laparoscopy. Dis Colon Rectum 53:1467-472View Article PubMed
  11.Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050-059View Article
  12.van der Pas MH et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210-18View Article PubMed
  13.Piskun et al (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparo-endosc Adv Surg Tech A 9:361-64View Article
  14.Esposito et al (1998) One-trocar appendectomy in pediatric surgery. Surg Endosc 12:177-78View Article PubMed
  15.Bucher P, Pugin F, Morel P (2008) Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013-016View Article PubMed
  16.Remzi FH et al (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823-26View Article PubMed
  17.Ross et al (2011) Early multi-institution experience with single-incision laparoscopic colectomy. Dis Colon Rectum 54:187-92View Article PubMed
  18.Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs. open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 138:1179-186View Article PubMed
  19.Steele SR, Brown TA, Rush RM, Martin MJ (2008) Laparoscopic vs. open colectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg 12:583-91View Article PubMed
  20.Greenblatt DY et al (2011) Short-term outcomes after laparoscopic-assisted proctectomy for rectal cancer: results from the ACS NSQIP. J Am Coll Surg 212(5):844-54View Article PubMed Central PubMed
  21.Lee Y et al (2012) A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn’s disease: an analysis of outcomes from the NSQIP database. Colorectal Dis 14(5):572-77View Article PubMed
  22.Kiran RP et al (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211(2):232-38View Article PubMed
  23.Merchant AM, Lin E (2009) Single-incision laparoscopic right hemicolectomy for a colon mass. Dis Colon Rectum 52:1021-024View Article PubMed
  24.Adair J, Gromski MA, Lim RB, Nagle D (2010) Single-incision laparoscopic right colectomy: experience with 17 consecutive cases and comparison with multiport laparoscopic right colectomy. Dis Colon Rectum 53:1549-554View Article PubMed
  25.Chen WT, Chang SC, Chiang HC et al (2011) Single-incision laparoscopic versus conventional laparoscopic right hemicolectomy: a comparison of short-term surgical results. Surg Endosc 25:1887-892View Article PubMed
  26.Leroy J et al (2009) Single access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144:173-79View Article PubMed
  27.Cahill RA et al (2010) Single port laparoscopic total colectomy for medically uncontrolled colitis. Dis Colon Rectum 53:1143-147View Article P
• 作者单位：John H. Marks (1) (2)
  Grace A. Montenegro (1) (2)
  Margaret V. Shields (1)
  Joseph L. Frenkel (1) (2)
  Gerald J. Marks (1) (2)
  
  1. Marks Colorectal Surgical Associates, Lankenau Institute for Medical Research, Wynnewood, PA, USA
  2. Lankenau Medical Center, Medical Office Building West, Suite 330, 100 East Lancaster Avenue, Wynnewood, PA, 19096, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Gynecology
  Gastroenterology
  Hepatology
  Proctology
  Abdominal Surgery
  
• 出版者：Springer New York
• ISSN：1432-2218

文摘

Introduction Single-port (SP) surgery has been characterized as having limited applicability regarding procedure, disease, and patient characteristics. There is a question if SP procedures offer disadvantages or advantages to multiport (MP) colorectal surgery. We hypothesize that SP is equivalent to MP and is a safe alternative in the full spectrum of colorectal disease and procedures. Methods A case-matched analysis of a prospectively maintained database to compare perioperative outcomes in SP versus MP was performed. Criteria included age, gender, BMI, previous abdominal surgery, previous XRT, disease process, and procedure. 95 exact matches for all 7 criteria were found between 159 SP and 1,617 MP cases. Perioperative outcomes, surgical technique, morbidity, mortality, local recurrence, and 5-year survival were analyzed. Results There was lower mean EBL in SP but no difference in transfusion requirement. OR time for SP left colectomy was shorter, with a trend to shorter OR times found in all procedures. 99?% SP and 98?% MP had no intra-operative complications. Conversion to open was equivalent (0/1). Mean largest incision was smaller for SP. There were no differences in return of bowel function or length of hospital stay. There were no mortalities. There were no differences in perioperative morbidity, local recurrence, distant metastasis, or overall 5-year survival. Conclusions SP is a safe alternative to MP colorectal surgery across the full array of procedures in equivalent patients. This study demonstrates SP has less blood loss, smaller incisions, is quicker in left colectomy, and tends to be quicker across all procedures. Conversion and morbidity rates are equivalent to MP, without compromise in quality of surgical technique. While proper training is essential, concerns regarding the inability to use SP laparoscopic colorectal surgery safely are unfounded in nearly exactly matched patients. These issues will require further study as SP laparoscopic colorectal surgery is practiced more widely.