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.	刘希, 陈诣佳, 黄伟, 等. 减孔腹腔镜直肠癌根治术临床研究新进展. 中国普外基础与临床杂志, 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.	刘若妍, 王亚楠, 张泽, 等. 经耻骨联合上单孔腹腔镜手术治疗乙状结肠及上段直肠癌的疗效分析. 中华胃肠外科杂志, 2016, 19(6): 647-653.
17.	陈浩林, 魏贤, 何家杰. SSILS 与常规腹腔镜手术治疗乙状结肠或上段直肠癌的疗效对比. 结直肠肛门外科, 2017, 23(5): 576-580.
18.	何承平. 不同结直肠癌手术临床疗效及术后并发症研究. 临床外科杂志, 2015, 23(7): 538-540.
19.	黄术胜. 单孔与传统腹腔镜乙状结肠及上段直肠癌根治术后近远期疗效对比研究. 中外医疗, 2016, 35(9): 13-15, 30.
20.	奚世文, 王大广, 张洋, 等. 单孔与传统腹腔镜乙状结肠癌根治术的单中心回顾性对比研究. 腹部外科, 2013, 26(4): 247-250.
21.	黄进堂, 王少勇, 张忠民, 等. 单孔腹腔镜与传统多孔腹腔镜直肠癌根治术的效果比较. 广东医学, 2016, 37(3): 389-392.
22.	苏洋, 吴硕东, 韩金岩, 等. 单孔与多孔腹腔镜直肠癌前切除术的疗效比较. 中华消化外科杂志, 2013, 12(5): 388-389.
23.	陈军, 吴佩, 茆家定. 腹腔镜结直肠癌手术新进展. 中国肿瘤外科杂志, 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.	周锋, 沙德胜. 单孔、多孔腹腔镜及开腹手术治疗直肠癌的临床效果对比. 中华普外科手术学杂志(电子版), 2019, 13(1): 22-24.
26.	王栋, 嵇振岭. 单孔腹腔镜手术专用器械研制及相关应用研究. 东南大学, 2015.
27.	田立志, 杜志江. 面向腹腔镜手术的力反馈型微器械研究. 哈尔滨工业大学, 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. 刘希, 陈诣佳, 黄伟, 等. 减孔腹腔镜直肠癌根治术临床研究新进展. 中国普外基础与临床杂志, 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. 刘若妍, 王亚楠, 张泽, 等. 经耻骨联合上单孔腹腔镜手术治疗乙状结肠及上段直肠癌的疗效分析. 中华胃肠外科杂志, 2016, 19(6): 647-653.
17. 陈浩林, 魏贤, 何家杰. SSILS 与常规腹腔镜手术治疗乙状结肠或上段直肠癌的疗效对比. 结直肠肛门外科, 2017, 23(5): 576-580.
18. 何承平. 不同结直肠癌手术临床疗效及术后并发症研究. 临床外科杂志, 2015, 23(7): 538-540.
19. 黄术胜. 单孔与传统腹腔镜乙状结肠及上段直肠癌根治术后近远期疗效对比研究. 中外医疗, 2016, 35(9): 13-15, 30.
20. 奚世文, 王大广, 张洋, 等. 单孔与传统腹腔镜乙状结肠癌根治术的单中心回顾性对比研究. 腹部外科, 2013, 26(4): 247-250.
21. 黄进堂, 王少勇, 张忠民, 等. 单孔腹腔镜与传统多孔腹腔镜直肠癌根治术的效果比较. 广东医学, 2016, 37(3): 389-392.
22. 苏洋, 吴硕东, 韩金岩, 等. 单孔与多孔腹腔镜直肠癌前切除术的疗效比较. 中华消化外科杂志, 2013, 12(5): 388-389.
23. 陈军, 吴佩, 茆家定. 腹腔镜结直肠癌手术新进展. 中国肿瘤外科杂志, 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. 周锋, 沙德胜. 单孔、多孔腹腔镜及开腹手术治疗直肠癌的临床效果对比. 中华普外科手术学杂志(电子版), 2019, 13(1): 22-24.
26. 王栋, 嵇振岭. 单孔腹腔镜手术专用器械研制及相关应用研究. 东南大学, 2015.
27. 田立志, 杜志江. 面向腹腔镜手术的力反馈型微器械研究. 哈尔滨工业大学, 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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