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

Abstract

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.

Single-incision versus conventional laparoscopic surgery for rectal cancer: a meta-analysis of clinical and pathological outcomes.

“…About 2 decades after the introduction of laparoscopic colectomy, SILS for colon cancer and SILS for rectal cancer were reported by Remzi et al [5] and Bulut and Nielsen [6]. Following clinical studies that compared the outcomes of SILS and CLS for colorectal surgery, some meta-analyses reported promising results, although there were some inconsistencies [36][37][38][39]. However, no meta-analysis has addressed the outcomes of SILS specifically for rectal surgery, which is technically more difficult than colon cancer surgery.…”

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

“…Postoperative complications such as bleeding, incision infection and anastomotic fistula were related to individual inclusion criteria such as age, nutritional status, underlying diseases and tumor scope. Under the same operation, the postoperative complications of good individual condition were significantly less than those of poor individual condition, so the occurrence of postoperative complications was difficult to be measured by the difference of surgical methods ( 9 ). Second, although SILS has a shorter incision length and fewer incisions than CLS ( 39 ), the improvement of equipment in recent years has led to more and more changes in the skills of surgeons.…”

“…In this meta-analysis, only 2 studies provided data on length of hospital stay. Because the included studies did not use the same discharge criteria and had a low sample size, differences in length of stay were of low reference value ( 9 ). In condition, different surgical instrument specifications and inconsistent surgical methods for colorectal cancer (such as low rectal cancer anterior resection, radical abdominal perineotomy combined with rectal cancer) may also affect the operative time and incidence of intraoperative complications.…”

“…Difficult to maintain pneumoperitoneum. The skills required for SILS differ from those required for CLS, SILS requires colorectal surgeons with superb laparoscopic skills, and surgeons need a learning curve cycle of 30-60 cases ( 9 ).…”

Apolipoprotein L3 enhances CD8+ T cell antitumor immunity of colorectal cancer by promoting LDHA-mediated ferroptosis

“…Colorectal cancer (CRC) is common around the world [1,2]. Development of early detection modalities has improved the survival of patients with colorectal cancer and surgical resection is considered the only chance to cure CRC [3,4]. However, In China, CRC still ranks as the third leading cause of cancer-associated mortality and late-stage colorectal cancer responds poorly to most chemotherapeutic agents [5].…”