A Systematic Review and Meta-Analysis of Single-Incision Versus Multiport Laparoscopic Complete Mesocolic Excision Colectomy for Colon Cancer

Abstract

Background. Our aim was to compare the emerging technique of single-incision laparoscopic surgery complete mesocolic excision (SILS CME) colectomy with the standard multiport laparoscopic CME (MPL CME) colectomy. Methods. MEDLINE (PubMed), Scopus, EMBASE, Ovid, and the Cochrane library were searched. Studies comparing the SILS CME with MPL CME in adults with colon adenocarcinoma were included. The Jadad and Newcastle Ottawa Scales were used to critically appraise the studies. The presence of statistical heterogeneity or publication bias was examined. Results. Seven studies (3 randomized) with a total number of 1344 patients were included (546 SILS CME and 798 MPL CME). No difference was found in anastomotic leakage (odds ratio [OR] = 0.79 [0.31 to 2.03]; P = .63), number of lymph nodes (weighted mean difference [WMD] = 0.85 [−0.97 to 2.66]; P = .36), hospital stay (WMD = 0.01 [−0.19 to 0.20]; P = .96), overall survival (hazard ratio [HR] = 1.19 [0.29 to 4.80]; P = .81), and disease-free survival (HR = 1.30 [0.30 to 5.61]; P = .72). Skin incision was shorter in SILS CME group (WMD = −3.02 [−3.25 to −2.80]; P < .00001) but with no difference in pain reported in postoperative day 1 (standardized mean difference [SMD] = −0.21 [−0.50 to 0.09]; P = .17) or day 2 (SMD = 0.16 [−0.52 to 0.84]; P = .64). Conclusions. SILS CME, although technically more demanding, has equivalent short- and long-term outcomes when compared with MPL CME. Potential benefits in cosmesis or postoperative pain need to be further explored by high-quality randomized controlled trials.

Comparison of clinical efficacy of single-incision and traditional laparoscopic surgery for colorectal cancer: A meta-analysis of randomized controlled trials and propensity-score matched studies

“…Compared with other previous meta-analysis ( 43 – 45 ) including retrospective studies or clinical controlled trials (CCTs), this meta-analysis only included and analyzed all relevant RCTs in the present to ensure that the results were more reliable. However, this study has some limitations.…”

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

“…Compared with other previous meta-analysis (37)(38)(39)(40) including retrospective studies or clinical controlled trials (CCTs), this meta-analysis only included and analyzed all relevant RCTs in the present to ensure that the results were more reliable. However, this study has some limitations.…”

Comparative effectiveness of pathological techniques to improve lymph node yield from colorectal cancer specimens: a systematic review and network meta‐analysis

“…1,7,8 Many factors may affect the nodal yield, such as age, gender, location of the tumour, tumour stage and body mass index, but the two modifiable ones are the extent of lymphadenectomy and the quality of the pathological examination. [9][10][11][12] The standard approach to identify lymph nodes is through manual palpation of the specimen; however, this may result in some lymph nodes being missed, particularly those smaller than 5 mm. 13 A number of specimen preparation techniques have been developed for improving lymph node retrieval, such as glacial acetic acid, ethanol, distilled water and formaldehyde (GEWF) solution, Carnoy's solution (ethanol, chloroform and 10% glacial acetic acid) and fat clearing containing xylene and alcohol have been reported to increase the nodal yield.…”

“…There is a high variability on reported lymph node yield between centres, but a significant number of colorectal cancer specimens remain that fail to reach this threshold 1,7,8 . Many factors may affect the nodal yield, such as age, gender, location of the tumour, tumour stage and body mass index, but the two modifiable ones are the extent of lymphadenectomy and the quality of the pathological examination 9–12 …”