Clinical efficacy of single-incision <i>versus</i> conventional laparoscopy for colorectal cancer: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

Lü Zhihao ¹ , LI Huixuan ² , LIANG Yuqi ² , XIAN Baiqing ¹ , GUO Chang ¹ , LIU Huaxi ³ , WEN Bin ² ,  HU Fengliang ⁴

1. The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China;
2. Institute of Spleen and Stomach, Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China;
3. School of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510515, P. R. China;
4. The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, P. R. China;

Corresponding?author：

HU Fengliang, Email: hahahu08@126.com

Keywords：

single-incision laparoscopy; conventional laparoscopy; colorectal cancer; efficacy

DOI：

10.7507/1007-9424.201903004

Video：

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Objective To compare clinical efficacy of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) in treatment of colorectal cancer.Methods The Pubmed, Embase, Cochrane library, CBM, CNKI, VIP, and Wanfang Data were searched to collect the comparative study of the SILS and CLS in the treatment of colorectal cancer. The data were extracted and evaluated by the RevMan 5.3 software.Results Eventually, 13 articles were included, including 3 randomized controlled trials and 10 case-control studies with a total of 1 466 patients. The meta-analysis results suggested that the SILS could shorten the postoperative hospital stay [MD=–0.63, 95% CI (–1.10, –0.16), P=0.009] and time to the first flatus [MD=–0.23, 95% CI (–0.33, –0.13), P<0.000 01] and the lymph node dissection was relatively completed [MD=0.77, 95% CI (0.05, 1.48), P=0.04] as compared with the CLS. In the total complications of surgery [OR=0.73, 95% CI (0.51, 1.03), P=0.08], operation time [MD=–0.33, 95% CI (–11.36, 10.69), P=0.95], intraoperative blood loss [MD=5.61, 95% CI (–4.20, 15.43), P=0.26], conversion to laparotomy [OR=1.06, 95% CI (0.18, 6.13), P=0.95], distance between tumor and proximal margin [MD=0.11, 95% CI (–0.48, 0.69), P=0.71], distance between tumor and distal margin [MD=0.32, 95% CI (–0.23, 0.87), P=0.25] had no statistically significant differences between the SILS and CLS.Conclusions SILS is safe and effective for radical resection of colorectal cancer. However, results of study still need to be validated by a randomized controlled trial with a large sample designed strictly.

Citation： Lü Zhihao, LI Huixuan, LIANG Yuqi, XIAN Baiqing, GUO Chang, LIU Huaxi, WEN Bin, HU Fengliang. Clinical efficacy of single-incision versus conventional laparoscopy for colorectal cancer: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(8): 964-973. doi: 10.7507/1007-9424.201903004 Copy

1.	Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
2.	Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis, 2008, 23(10): 1013-1016.
3.	Remzi FH, Kirat HT, Kaouk JH, et al. Single-port laparoscopy in colorectal surgery. Colorectal Dis, 2008, 10(8): 823-826.
4.	Far SS, Miraj S. Single-incision laparoscopy surgery: a systematic review. Electron Physician, 2016, 8(10): 3088-3095.
5.	劉希, 陳詣佳, 黃偉, 等. 減孔腹腔鏡直腸癌根治術臨床研究新進展. 中國普外基礎與臨床雜志, 2018, 25(10): 1270-1275.
6.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. New York, NY: Cochrane Collaboration, John Wiley and Sons, 2008.
7.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
8.	Wells G, Shea B, Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. (2012-04-26)[2019-02-20]. http://www.o-hri.ca/programs/clinical_epidemiology/oxford.asp.
9.	Taggart DP, D'Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet, 2001, 358(9285): 870-875.
10.	Fujii S, Watanabe K, Ota M, et al. Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case-control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost. Surg Endosc, 2012, 26(5): 1403-1411.
11.	Watanabe J, Ota M, Fujii S, et al. Randomized clinical trial of single-incision versus multiport laparoscopic colectomy. Br J Surg, 2016, 103(10): 1276-1281.
12.	Kim SJ, Choi BJ, Lee SC. Successful total shift from multiport to single-port laparoscopic surgery in low anterior resection of colorectal cancer. Surg Endosc, 2014, 28(10): 2920-2930.
13.	Lim SW, Kim HR, Kim YJ. Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy. Ann Surg Treat Res, 2014, 87(3): 131-138.
14.	Yun JA, Yun SH, Park YA, et al. Single-incision laparoscopic right colectomy compared with conventional laparoscopy for malignancy: assessment of perioperative and short-term oncologic outcomes. Surg Endosc, 2013, 27(6): 2122-2130.
15.	Lu CC, Lin SE, Chung KC, et al. Comparison of clinical outcome of single-incision laparoscopic surgery using a simplified access system with conventional laparoscopic surgery for malignant colorectal disease. Colorectal Dis, 2012, 14(4): e171-e176.
16.	劉若妍, 王亞楠, 張澤, 等. 經恥骨聯合上單孔腹腔鏡手術治療乙狀結腸及上段直腸癌的療效分析. 中華胃腸外科雜志, 2016, 19(6): 647-653.
17.	陳浩林, 魏賢, 何家杰. SSILS 與常規腹腔鏡手術治療乙狀結腸或上段直腸癌的療效對比. 結直腸肛門外科, 2017, 23(5): 576-580.
18.	何承平. 不同結直腸癌手術臨床療效及術后并發癥研究. 臨床外科雜志, 2015, 23(7): 538-540.
19.	黃術勝. 單孔與傳統腹腔鏡乙狀結腸及上段直腸癌根治術后近遠期療效對比研究. 中外醫療, 2016, 35(9): 13-15, 30.
20.	奚世文, 王大廣, 張洋, 等. 單孔與傳統腹腔鏡乙狀結腸癌根治術的單中心回顧性對比研究. 腹部外科, 2013, 26(4): 247-250.
21.	黃進堂, 王少勇, 張忠民, 等. 單孔腹腔鏡與傳統多孔腹腔鏡直腸癌根治術的效果比較. 廣東醫學, 2016, 37(3): 389-392.
22.	蘇洋, 吳碩東, 韓金巖, 等. 單孔與多孔腹腔鏡直腸癌前切除術的療效比較. 中華消化外科雜志, 2013, 12(5): 388-389.
23.	陳軍, 吳佩, 茆家定. 腹腔鏡結直腸癌手術新進展. 中國腫瘤外科雜志, 2013, 5(6): 383-386.
24.	Morales-Conde S, Peeters A, Meyer YM, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc, 2019, 33(4): 996-1019.
25.	周鋒, 沙德勝. 單孔、多孔腹腔鏡及開腹手術治療直腸癌的臨床效果對比. 中華普外科手術學雜志(電子版), 2019, 13(1): 22-24.
26.	王棟, 嵇振嶺. 單孔腹腔鏡手術專用器械研制及相關應用研究. 東南大學, 2015.
27.	田立志, 杜志江. 面向腹腔鏡手術的力反饋型微器械研究. 哈爾濱工業大學, 2010.

1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
2. Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis, 2008, 23(10): 1013-1016.
3. Remzi FH, Kirat HT, Kaouk JH, et al. Single-port laparoscopy in colorectal surgery. Colorectal Dis, 2008, 10(8): 823-826.
4. Far SS, Miraj S. Single-incision laparoscopy surgery: a systematic review. Electron Physician, 2016, 8(10): 3088-3095.
5. 劉希, 陳詣佳, 黃偉, 等. 減孔腹腔鏡直腸癌根治術臨床研究新進展. 中國普外基礎與臨床雜志, 2018, 25(10): 1270-1275.
6. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. New York, NY: Cochrane Collaboration, John Wiley and Sons, 2008.
7. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
8. Wells G, Shea B, Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. (2012-04-26)[2019-02-20]. http://www.o-hri.ca/programs/clinical_epidemiology/oxford.asp.
9. Taggart DP, D'Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet, 2001, 358(9285): 870-875.
10. Fujii S, Watanabe K, Ota M, et al. Single-incision laparoscopic surgery using colon-lifting technique for colorectal cancer: a matched case-control comparison with standard multiport laparoscopic surgery in terms of short-term results and access instrument cost. Surg Endosc, 2012, 26(5): 1403-1411.
11. Watanabe J, Ota M, Fujii S, et al. Randomized clinical trial of single-incision versus multiport laparoscopic colectomy. Br J Surg, 2016, 103(10): 1276-1281.
12. Kim SJ, Choi BJ, Lee SC. Successful total shift from multiport to single-port laparoscopic surgery in low anterior resection of colorectal cancer. Surg Endosc, 2014, 28(10): 2920-2930.
13. Lim SW, Kim HR, Kim YJ. Single incision laparoscopic colectomy for colorectal cancer: comparison with conventional laparoscopic colectomy. Ann Surg Treat Res, 2014, 87(3): 131-138.
14. Yun JA, Yun SH, Park YA, et al. Single-incision laparoscopic right colectomy compared with conventional laparoscopy for malignancy: assessment of perioperative and short-term oncologic outcomes. Surg Endosc, 2013, 27(6): 2122-2130.
15. Lu CC, Lin SE, Chung KC, et al. Comparison of clinical outcome of single-incision laparoscopic surgery using a simplified access system with conventional laparoscopic surgery for malignant colorectal disease. Colorectal Dis, 2012, 14(4): e171-e176.
16. 劉若妍, 王亞楠, 張澤, 等. 經恥骨聯合上單孔腹腔鏡手術治療乙狀結腸及上段直腸癌的療效分析. 中華胃腸外科雜志, 2016, 19(6): 647-653.
17. 陳浩林, 魏賢, 何家杰. SSILS 與常規腹腔鏡手術治療乙狀結腸或上段直腸癌的療效對比. 結直腸肛門外科, 2017, 23(5): 576-580.
18. 何承平. 不同結直腸癌手術臨床療效及術后并發癥研究. 臨床外科雜志, 2015, 23(7): 538-540.
19. 黃術勝. 單孔與傳統腹腔鏡乙狀結腸及上段直腸癌根治術后近遠期療效對比研究. 中外醫療, 2016, 35(9): 13-15, 30.
20. 奚世文, 王大廣, 張洋, 等. 單孔與傳統腹腔鏡乙狀結腸癌根治術的單中心回顧性對比研究. 腹部外科, 2013, 26(4): 247-250.
21. 黃進堂, 王少勇, 張忠民, 等. 單孔腹腔鏡與傳統多孔腹腔鏡直腸癌根治術的效果比較. 廣東醫學, 2016, 37(3): 389-392.
22. 蘇洋, 吳碩東, 韓金巖, 等. 單孔與多孔腹腔鏡直腸癌前切除術的療效比較. 中華消化外科雜志, 2013, 12(5): 388-389.
23. 陳軍, 吳佩, 茆家定. 腹腔鏡結直腸癌手術新進展. 中國腫瘤外科雜志, 2013, 5(6): 383-386.
24. Morales-Conde S, Peeters A, Meyer YM, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc, 2019, 33(4): 996-1019.
25. 周鋒, 沙德勝. 單孔、多孔腹腔鏡及開腹手術治療直腸癌的臨床效果對比. 中華普外科手術學雜志(電子版), 2019, 13(1): 22-24.
26. 王棟, 嵇振嶺. 單孔腹腔鏡手術專用器械研制及相關應用研究. 東南大學, 2015.
27. 田立志, 杜志江. 面向腹腔鏡手術的力反饋型微器械研究. 哈爾濱工業大學, 2010.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical efficacy of single-incision versus conventional laparoscopy for colorectal cancer: a meta-analysis

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