Abstract
Introduction Innovative laparoscopic surgery for rectal cancer can be classified into 2 types: firstly, new instruments such as robotic surgery and secondly, new technique such as single-access laparoscopic surgery (SALS) and transanal total mesorectal excision (TaTME). Most reports of SALS for rectal cancer have shown pathologic outcomes comparable to those of conventional laparoscopic surgery (CLS); however, SALS is considered to be superior to CLS in terms of lower levels of discomfort and faster recovery rates. This study aimed to compare the survival outcomes of the two approaches. Methods From 2011 to 2014, 84 cases of adenocarcinoma of the rectum and anal canal were enrolled. The operations were anterior, low anterior, intersphincteric, and abdominoperineal resections. Data collected included postoperative outcomes. The oncological outcomes recorded included 3-year and 5-year survival, local recurrence, and metastasis. Results SALS was performed on 41 patients, and CLS was utilized in 43 cases. The demographic data of the two groups were similar. Intraoperative volumes of blood loss and conversion rates were similar, but operative time was longer in the SALS group. There were no significant differences in postoperative complications or pathological outcomes. The oncologic results were similar in terms of 3-year survival (100% and 97.7%; p = 1.00), 5-year survival (78.0% and 86.0%; p = 0.401), local recurrence rates (19.5% vs 11.6%, p = 0.376), and metastasis rates (19.5% vs 11.6%; p = 0.376) for SALS and CLS, respectively. Conclusion SALS and CLS for rectal and anal cancer had comparable pathological and survival results, but SALS showed some superior benefits in the early postoperative period.
Highlights
Innovative laparoscopic surgery for rectal cancer can be classified into 2 types: firstly, new instruments such as robotic surgery and secondly, new technique such as single-access laparoscopic surgery (SALS) and transanal total mesorectal excision (TaTME)
With regard to rectal cancer, several studies have demonstrated that laparoscopic surgery is safe and effective and does not compromise oncological outcomes; thereby, it is often recommended as an alternative method to open surgery in many international guidelines [6,7,8,9,10]
Single-access laparoscopic surgery (SALS) is a surgical technique that was developed to improve upon multiport conventional laparoscopic surgery (CLS) by limiting incisions and alleviating pain. e concept lies in the use of a single multichannel port site to perform the entire procedure; in rectal cancer, there are some drawbacks, such as instrument collision, reduced ability to create a working space in narrow pelvises, and endostaple application problems. e current author has previously reported some of the techniques used to facilitate this type of surgery in rectal cancer and its short-term outcomes [11,12,13]; the longterm oncological results are still debated
Summary
Laparoscopic surgery is a generally accepted surgical technique for colorectal cancer surgery and is superior to the open approach in some outcomes such as faster postoperative recovery, shorter length of hospital stay (LHS), and potentially reduced postoperative mortality [1,2,3,4,5]. We report the long-term oncological outcomes of SALS for rectal and anal adenocarcinoma. Data were collected in 4 stages: first, preoperative demographic data were collated together with details of type of operation (Table 1); second, intraoperative and early postoperative data such as operative time, blood loss volume, complications, pain score using the visual analog scale, wound length (SALS group only), hospital stay, and conversion rate were recorded (Table 2); third, pathological outcomes including stage, mesorectal grade, and surgical margin were reported (Table 3); and lastly, oncological outcomes were analyzed
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