Abstract
Advancement of the surgical modality and perioperative care are the two main dimensions for the modern improvement of surgical outcome. The purpose of this study was to compare the effectiveness of the two by using the data from the single-port laparoscopic surgery and the early recovery after surgery (ERAS) program. Patients who underwent elective surgery for primary adenocarcinoma of the colon were divided into three groups and compared: ERAS (multi-port laparoscopic surgery with ERAS perioperative care), Conventional-SILS (single-port surgery with conventional perioperative care), or Conventional-Multi (multi-port laparoscopic surgery with conventional perioperative care). Ninety-one, 83, and 96 patients were registered, respectively. There were no differences among the three groups in baseline characteristics except pathological stage and operation site in colon. Although the ERAS group started a soft diet earlier and had earlier discharge, there were no differences in intra- and post-operative morbidity rate, readmission rate, or reoperation rate. The ERAS perioperative care was a significant factor for reducing length of hospital stay in the multivariate analysis, while single-port surgery was not. In modern laparoscopic colon cancer treatment, a systemic approach such as the ERAS program appears to be more effective than a technical approach for significantly improving short-term surgical outcomes.
Highlights
Short- and long-term outcomes of colorectal cancer surgery are improving due to a number of advancements, including minimally invasive surgery, the principle of total mesorectal excision/complete mesocolic excision, a multidisciplinary team approach, and the development of chemotherapy in the modern era
Sex, body mass index (BMI), history of previous abdominal surgery, and preoperative serum carcinoembryonic antigen (CEA) level did not differ among the three groups
In the early recovery after surgery (ERAS) group, a significant number of patients had their lesion in the cecum ~ proximal T colon, and right hemi-colectomy (RHC) or extended RHC were significantly higher than in the other two groups (49.5% vs. 22.9% vs. 22.9%, p < 0.001)
Summary
Short- and long-term outcomes of colorectal cancer surgery are improving due to a number of advancements, including minimally invasive surgery, the principle of total mesorectal excision/complete mesocolic excision, a multidisciplinary team approach, and the development of chemotherapy in the modern era. ERAS is known to reduce postoperative complications, hasten recovery, and reduce the length of hospital stay2,3 Another approach, single-port laparoscopic surgery, is reported to have a cosmetic effect, and decrease intraoperative blood loss and postoperative length of hospital stay by enhancing recovery of bowel movements due to further shortening of the incision length compared to conventional multi-port laparoscopic surgery. Single-port laparoscopic surgery, is reported to have a cosmetic effect, and decrease intraoperative blood loss and postoperative length of hospital stay by enhancing recovery of bowel movements due to further shortening of the incision length compared to conventional multi-port laparoscopic surgery4 Both methods can improve short-term performance in colon cancer surgery, but one is a systemic approach requiring cooperation from experts in different fields, and the other is a technical approach, dependent on the ability of the surgeon. The purpose of this study was to compare the efficacy of ERAS, which strengthens the systemic approach, and single-port laparoscopic surgery, which strengthens the technical approach, for improving postoperative outcome
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
