Single-incision laparoscopic surgery for colorectal cancer

Abstract

We now see a great increase in the use of minimally invasive surgery for the treatment of solid tumors [1]. Patients and their physicians are increasingly seeking cancer-specialized institutions to benefit from cancer management by a multidisciplinary team. This fact has increased the competition among hospitals and surgeons. As a result, laparoscopic surgery has rapidly become involved given that it is associated with a shorter hospital stay, less postoperative pain and scarring, and lower risk of infection and for the need for blood transfusion than open surgery. For the treatment of gastrointestinal cancers, the use of laparoscopic surgery has progressed very fast [2–7]. A paradigm of rapid evolution in the treatment of colorectal cancer with laparoscopic surgery is presented in the study by Ramos-Valadez et al. [8], published in the October issue of Surgical Endoscopy. Using a rapidly emerging technique—the single-incision laparoscopic colectomy (SILC)—the authors evaluated the safety and feasibility of performing SILC for a right hemicolectomy using the SILS Port Multiple Instrument Access Port (Covidien, Mansfield, MA). Within 4 months, a SILC right hemicolectomy was performed in 13 consecutive, unselected patients with a benign or malignant tumor. Demographic data, intraoperative parameters, and postoperative outcomes were assessed. Two cases required conversion to a hand-assisted procedure. In 11 patients, the SILC procedure was performed with a mean incision length of 3.1 cm and a mean operative time of 131 min. Operative time was related to the body mass index. Among the five patients with malignant tumor, the mean number of lymph nodes resected and evaluated by pathologists was 26. There were no intraoperative complications and only one postoperative complication. The safety of SILC is reflected in the overall mean hospital stay of only 2.5 days. Based on these results, the authors concluded that the SILC procedure is a safe and feasible procedure for treating benign and malignant diseases requiring a right hemicolectomy. Indeed, although this was a small retrospective study, it provides evidence that SILC can be performed with a low complication rate and a short postoperative hospital stay. It should be noted, however, that these excellent results are from a study conducted at a highly specialized institution by surgeons who have performed a high volume of minimally invasive surgeries. Therefore, reports that include a larger number of patients treated with this technique, particularly in low-volume hospitals, should be awaited to assess the safety of single-incision laparoscopic surgery in the treatment of colorectal cancer. Recently, complete laparoscopic colorectal cancer resection (R0), including resection of a sufficient number of examined lymph nodes, has been reported. Despite this procedure and adjuvant systemic chemotherapy and radiotherapy, recurrence and death rates from cancer still remain high. With respect to adjuvants, there is still no evidence that the anti-EGFR agents cetuximab and panitumumab can improve overall survival and cure rates. However, there is evidence for progression-free survival benefit without any overall survival benefit and this effect is limited to genotype-based selection of patients with wild-type KRAS status in the metastatic setting [9, 10]. Similarly, caution is suggested for use of the anti-VEGF drug bevacizumab, for which the latest evidence indicates lower expectations for overall survival benefit without biomarker-based selection of patients with solid tumors [11]. These results with modest efficacy and true response C. Hottenrott (&) Chirurgische Klinik, St. Elisabethenkrankenhaus Ginnheimer Strase 3, 60487 Frankfurt, Germany e-mail: info@gastricbreastcancer.com