Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases.
BACKGROUND
The aim of this study was to reveal the short-term and long-term outcomes of single-incision laparoscopic colorectal resection (SILC) compared with multi-incision laparoscopic colorectal resection (MILC) for colorectal cancer using propensity score matching analysis.


METHODS
The study group included 235 patients who underwent SILC and 730 patients who underwent MILC for colorectal cancer between April 2009 and September 2014. The propensity score matching for age, gender, body mass index, tumor location (right-sided colon/sigmoid colon/upper rectum), lymph node dissection (D1/D2/D3), pathologic T (≤T3) stage and TNM (0-I/II/III) stage produced 107 matched pairs. The exclusion criteria for SILC were as follows: (1) tumors located at the transverse, descending colon or lower rectum, (2) stage IV tumors, synchronous or previous malignancies, (3) locally advanced tumors >T4, (4) acute obstructions or previous major abdominal surgery and (5) obese patients: BMI > 30.


RESULTS
No significant differences were observed in operating time, bleeding volumes, starting time of liquid diet and length of hospital stay between the SILC and MILC groups. However, the SILC group showed less analgesic requirements (1.1 vs. 1.9 times; p = 0.0006) and shorter length of incision (2.7 vs. 4.3 cm; p = 0.0000) compared to MILC group. The overall rate of postoperative complications was similar in both groups (2.8 vs. 3.7%, p = 0.70). The 5-year overall survival rate of SILC and MILC was 100 and 95% (p = 0.125) and 5-year disease-free survival rates in stages 0-III were 97 and 94% (p = 0.189), 100 and 92% in stage II and 90 and 85% in stage III, respectively.


CONCLUSIONS
This study suggests that SILC for colorectal cancer is a safe and feasible option with better cosmetic results and less pain in strictly selected patients. SILC can also produce good oncological results with similar postoperative outcomes to MILC.
['Katsuno|Goutaro|G|', 'Fukunaga|Masaki|M|', 'Nagakari|Kunihiko|K|', 'Yoshikawa|Seichiro|S|', 'Azuma|Daisuke|D|', 'Kohama|Shintaro|S|']
D000368:Aged D000700:Analgesics D015331:Cohort Studies D015179:Colorectal Neoplasms D004363:Drug Utilization D005260:Female D006801:Humans D010535:Laparoscopy D008297:Male D016555:Matched-Pair Analysis D057216:Propensity Score D012189:Retrospective Studies
Propensity score Colon cancer Rectal cancer Single-incision laparoscopic surgery