Systematic review of single-incision versus conventional multiport laparoscopic surgery for sigmoid colon and rectal cancer

Abstract

Objectives: To explore whether single-incision laparoscopic surgery (SILS) has the better short-term clinical and pathological outcomes than conventional multiport laparoscopic surgery (CLS) for sigmoid colon and rectal cancer.

Methods: A literature investigation of MEDLINE, PubMed, Ovid, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Biological Medicine (CBM), and Wanfang databases for relevant researches was performed. Fixed effects and random effects models were used to calculate the corresponding outcomes. Standardized mean difference and risk ratio were calculated for continuous and dichotomous variables separately.

Results: Nine clinical controlled trials were composed of two randomized clinical trials and seven non-randomized clinical trials with a total of 829 patients. Two hundred ninety-nine (36.1%) patients underwent SILS, and 530 (63.9%) patients underwent CLS. The meta-analysis showed that SILS had more lymph node resection (SMD - 0.25, 95% CI - 0.50 to - 0.002) and less defecation time (SMD - 0.46, 95% CI - 0.75 to - 0.17), exhaust time (SMD - 0.46, 95% CI - 0.75 to - 0.18), and hospital stay (SMD - 0.30, 95% CI - 0.45 to - 0.15 than CLS. SILS was also accompanied with shorter incision length (SMD - 2.46, 95% CI - 4.02 to - 0.90), less pain score (SMD - 0.56, 95% CI - 0.91 to - 0.21), and lower complication rate (RR 0.66, 95% CI 0.47 to 0.91). Blood loss, operative time, distal margin, conversion rate, anastomotic fistula, readmission, local recurrence, and distant metastasis showed no statistical differences in two groups. In all subgroup analysis, SILS also had advantages of incision length, operative time, defecation time, exhaust time, and hospitalization time than CLS.

Conclusion: SILS could be a more safe and reliable surgical technique than CLS for sigmoid colon and rectal cancer. However, further high-quality studies between these two techniques need to be further developed.

Keywords: Laparoscopic surgery; Meta-analysis; Sigmoid colon and rectal cancer; Single-incision.

Fig. 1

Flowchart of the included studies

Fig. 2

Forest plot of intraoperative outcome. a Operation time, b incision length, c amount of bleeding, d conversion rates, e lymph node resection, and f distal surgical edge (DSE)

Fig. 3

Forest plot of postoperative outcomes. a Complication, b anastomotic leakage, c defecation time, d exhaust time, e pain score, and f hospitalization time

Fig. 4

Forest plot of mid-term outcomes. a Readmission, b local recurrence, c metastasis and sigmoid colon cancer versus rectal cancer: d complication and e incision length, operation time, and hospitalization time

Fig. 5

Forest plot of eastern versus western patients. a Complication, b defecation time, exhaust time, incision length, lymph node resection, pain score, and hospital stay. English versus Chinese studies: c complication and conversion; d incision length, lymph node resection, and hospital stay; and e defecation time, exhaust time, distal surgical edge, and hospital stay