Short-term Outcomes of Single-port Versus Multiport Laparoscopic Surgery for Colon Cancer

Lee, Yoon Suk; Kim, Ji Hoon; Kim, Hyung Jin; Lee, Sang Chul; Kang, Byung Mo; Kim, Chang Woo; Lim, Sangwoo; Lee, Suk-Hwan; Kim, Jun Gi

doi:10.1097/sla.0000000000003882

Cited by 47 publications

(69 citation statements)

References 26 publications

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“…An asymmetrical inverted funnel plot for postoperative complications from egger's test ( t = 1.78, p = 0.33), publication bias were not detected as a result of postoperative complications ( Figure 12 ) ( 20 , 28 ). Publication bias were not detected on intraoperative complications using the egger's test ( t = 2.41, p = 0.14, p > 0.05) ( 21 – 23 ). The heterogeneity test for length of abdominal incision showed ( P = 0.002, I 2 = 76%), high heterogeneity.…”

Section: Resultsmentioning

confidence: 93%

“…Huscher et al ( 21 ) reported that no patient with anastomotic leakage was found in SILS group and one patient with anastomotic leakage was found in CLS group. Lee et al ( 23 ) reported that two patients with anastomotic leakage were found in SILS group and one patient with anastomotic leakage was found in CLS group. Chen et al ( 25 ) reported that there was one patient with anastomotic leakage in SILS group and CLS group separately.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies ( 19 , 20 , 22 , 23 , 26 ) with a total of 759 patients reported the rate of conversion to laparotomy. Heterogeneity test: P = 0.41, I 2 = 0, showed no heterogeneity.…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis results [RR = 0.45, 95% CI: 0.10–1.99, P = 0.30], showed no statistical significance. Major abdominal surgery history: The effects of two studies ( 22 , 23 ), with a total of 421 patients were combined to perform the meta-analysis. Heterogeneity test: P = 0.87, I 2 = 0, showed no heterogeneity.…”

Section: Resultsmentioning

confidence: 99%

“…In the studies we included, the definitions of conversion to CLS cannot be unified. Conversion to CLS was defined as the insertion of additional trocars during SILS in two studies ( 20 , 22 ), but in other studies, conversion to CLS was defined as the addition of two or more trocars ( 23 , 26 ). The definition of conversion to laparotomy was that a skin incision longer than designated incision was required to extract the resected specimen or to control intraoperative complications in two studies ( 20 , 22 ), but in another study, conversion to laparotomy was defined by a wound length measuring 8 cm or greater ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

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Single-Incision vs. Conventional Laparoscopic Surgery for Colorectal Cancer: An Update of a Systematic Review and Meta-Analysis

et al. 2021

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Background: Although the advantages of single-incision laparoscopic surgery have been reported in several meta-analyses, the low quality of studies included in the meta-analyses limits the reliability of such a conclusion. In recent years, the number of randomized controlled trials on the efficacy of SILS in colorectal cancer has been on the rise. This update systematic review and meta-analysis of RCTs aims to compare efficacy and safety of SILS and CLS in the patients with colorectal cancer.Methods: Relevant data was searched on the CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, and Cochrane CENTRAL databases from inception until February 5th, 2021. All RCTs comparing SILS and CLS were included. The main outcomes were 30 days of mortality, postoperative complications, intraoperative complications, whereas secondary outcomes were the number of lymph nodes removed, duration of hospital stay, intraoperative blood loss, abdominal incision length, reoperation, readmission, conversion to laparotomy, operation time and anastomotic leakage.Results: A total of 10 RCTs were included, involving 1,133 participants. The quality of the included studies was generally high. No significant difference was found between SILS and CLS in the 30 days mortality rate. The results showed that SILS group had a lower rate of postoperative complications (RR = 0.67, 95% CI: 0.49–0.92), higher rate of intraoperative complications (RR = 2.26, 95%CI: 1.00–5.10), shorter length of abdominal incision (MD = −2.01, 95% CI:−2.42–1.61) (cm), longer operation time (MD = 11.90, 95% CI: 5.37–18.43) (minutes), shorter hospital stay (MD = −1.12, 95% CI: −1.89–0.34) (days) compared with CLS group. However, intraoperative blood loss (MD = −8.23, 95% CI: −16.75–0.29) (mL), number of lymph nodes removed (MD = −0.17, 95% CI: −0.79–0.45), conversion to laparotomy (RR=1.31, 95% CI: 0.48–3.60), reoperation (RR = 1.00, 95% CI: 0.30–3.33) and readmission (RR =1.15, 95% CI: 0.12–10.83) and anastomotic leakage were not significantly different between the two groups.Conclusion: These results indicate that SILS did not has a comprehensive and obvious advantage over the CLS. Surgeons and patients should carefully weigh the pros and cons of the two surgical procedures. Further RCTs are needed to prove long-term outcomes of SILS in colorectal cancer.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

“…Five studies ( 19 , 20 , 22 , 23 , 26 ) with a total of 759 patients reported the rate of conversion to laparotomy. Heterogeneity test: P = 0.41, I 2 = 0, showed no heterogeneity.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Single-Incision vs. Conventional Laparoscopic Surgery for Colorectal Cancer: An Update of a Systematic Review and Meta-Analysis

et al. 2021

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Clinical outcomes of single incision laparoscopic surgery for colorectal cancer: A propensity score‐matched analysis between well‐experienced and novice surgeons

Tei

Suzuki

Ohtsuka

et al. 2022

Annals of Gastroent Surgery

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Background Single incision laparoscopic surgery (SILS) is a recent advancement in minimally invasive techniques for colorectal cancer (CRC). However, SILS is a technically challenging procedure for novice surgeons. The aim of this study was to evaluate clinical outcomes of SILS for CRC performed by novice surgeons compared with those performed by well‐experienced surgeons. Methods We retrospectively analyzed 1004 consecutive patients with stage I‐IV CRC who underwent SILS between May 2009 and December 2018, using propensity score‐matched analysis. Results After propensity score‐matching, we enrolled 344 patients (n = 172 in each group). Before matching, significant group‐dependent differences were observed in terms of age (P = 0.034) and tumor location (P < 0.001). After matching, preoperative clinical factors were similar between groups, but operative time was longer in the Novice group (213 vs 171 min, P < 0.001). Other operative factors and morbidity rates did not differ significantly between groups. The number of harvested lymph nodes was smaller in the Novice group (23 vs 25, P = 0.040), and the number of patients with lymph node metastases was smaller in the Novice group (57 vs 86, P = 0.002). The 3‐year disease‐free survival rate was 85.8% in the Novice group and 89.9% in the Experienced group (P = 0.512). Three‐year overall survival rate was 92.2% in the Novice group and 90.0% in the Experienced group (P = 0.899). Conclusion SILS for CRC was safely performed by novice surgeons under the guidance of well‐experienced surgeons, and could provide satisfactory oncological outcomes.

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Learning curve of trans‐areola single‐site endoscopic thyroidectomy in a high‐volume center: A CUSUM‐based assessment

et al. 2023

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BackgroundLimited attempts have been made in trans‐areola single‐site endoscopic thyroidectomy (TASSET) due to technical challenges and the lengthy time for proficiency. This study aimed to define the learning curve of TASSET and to describe improvements in operative performance over time.MethodsBased on 222 consecutive TASSET procedures, the learning curve was established according to the operation time by using cumulative sum analysis (CUSUM). The end‐point of learning curve was defined as the number of cases necessitated to reach the initial surgical proficiency stage. The demographic information, surgical and oncological outcomes, surgical stress, and postoperative complications were also analyzed.ResultsThere were 70 cases of simple lobectomy for benign nodules and 152 cases of lobectomy with central neck dissection (CND) for malignancy. The mean operative time was 106.54 ± 38.07 min (range: 46–274 min). The learning curve identified two phases: the skill acquisition phase (Case 1–Case 41) and the proficiency phase (Case 42–Case 222). There were no significant differences in demographic information, drainage amount and duration, oncological outcomes, and postoperative complications between the two phases (p > 0.05). Both operation time and postoperative hospitalization decreased significantly in Phase 2 (154.63 ± 52.21 vs. 95.64 ± 22.96 min, p < 0.001; 4.12 ± 0.93 vs. 3.65 ± 0.63 days, p < 0.001). Additionally, the mean variations of surgical stress factors (C‐reactive protein and erythrocyte sedimentation rate) decreased significantly as the phase progress. The case number required for proficiency phase in benign and malignant tumor were 18 and 33, respectively, and lymph node resection posed a significant impact on the endpoint of the learning curve (p < 0.001). Meanwhile, the size of nodule showed no significant impact (p = 0.622). For right‐handed surgeons, 16 cases and 25 cases were required for technical competence in left‐sided and right‐sided lesions, respectively, and no significant difference reached (p = 0.266).ConclusionsTASSET has demonstrated safe and technically feasible with comparable oncological outcomes. Experience of 41 cases was required for surgical competence and proficiency. The initial learning stage could be more quickly adopted by high‐volume thyroid surgeons with standardized procedures.

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Short-term Outcomes of Single-port Versus Multiport Laparoscopic Surgery for Colon Cancer

Cited by 47 publications

References 26 publications

Single-Incision vs. Conventional Laparoscopic Surgery for Colorectal Cancer: An Update of a Systematic Review and Meta-Analysis

Single-Incision vs. Conventional Laparoscopic Surgery for Colorectal Cancer: An Update of a Systematic Review and Meta-Analysis

Clinical outcomes of single incision laparoscopic surgery for colorectal cancer: A propensity score‐matched analysis between well‐experienced and novice surgeons

Learning curve of trans‐areola single‐site endoscopic thyroidectomy in a high‐volume center: A CUSUM‐based assessment

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