Surgery In Colorectal Cancer Patients Research Articles

К вопросу выбора тактики лечения при метастатическом колоректальном раке

Treatment outcomes of 176 colorectal cancer patients with liver metastases were retrospectivelly analyzed. There were 86 men and 90 women in the age range 28 to 84 years. Multiple metastasis was detected in 79.5 % of patients and solitary metastasis in 20.5 % of patients. Cytoreductive surgery was performed in 30.7 % of patients and palliative surgery in 57.9 %. Surgical treatment was not performed in 5.1% of patients. The median survival time of patients after symptomatic surgeries was 10.8 months (1.5-26 months). Cytoreductive surgery increased the median survival time by more than 2 months (13 months, 2–44 months). Thus, radical surgery for colorectal cancer patients with liver metastases is justified by the increase in the median survival time of the patients.

Outcome of salvage surgery for colorectal cancer initially treated by upfront endoscopic therapy

Recent advances in endoscopic therapy, including conventional endoscopic resection and endoscopic submucosal dissection (ESD), have led to a large number of patients with early colorectal cancer (CRC) being cured; however, when resected specimens obtained by these procedures manifest risk factors for lymph node metastasis, additional treatments need to be considered. The aim of our study was to evaluate the outcomes of salvage surgery in CRC patients treated initially by advanced therapeutic endoscopy. We investigated 145 patients who underwent salvage surgery in our department after endoscopic therapy for CRC between April 2006 and March 2015. Demographic and pathological data, endoscopic procedures, reasons for surgery, and operative outcomes, including perioperative details and recurrence-free and disease-specific survival after surgery, were analyzed. These data were further compared with those of 59 patients with submucosal invasive CRC treated by conventional endoscopic resection/ESD alone and 133 patients treated by surgery alone. Overall lymph node metastases were observed in 14% of patients who underwent salvage surgery after therapeutic endoscopy and 16% of those who received abdominal surgery alone. In analyses of surgical cases, patients with lymph node metastases more frequently included cases with lymphatic infiltration (63%) and ESD-treated cases (45%) than those without metastases (21%, P < .0001 and 22%, P = .02; respectively). A logistic regression analysis identified lymphatic infiltration as an independent predictive factor for lymph node metastases (odds ratio: 8.77, 95% confidence interval: 2.90-33.31, P < .0001). Long-term outcomes were favorable in both lymphatic infiltration-negative and positive cases. Moreover, survivals were comparable among the different treatment groups. Because of the high rate of nodal involvement, adequate lymphadenectomy need to be performed in salvage surgery after upfront endoscopic therapy.

Association between preoperative C-reactive protein level and colorectal cancer survival: a meta-analysis.

C-reactive protein (CRP) is widely known as a major nonspecific systemic inflammatory marker. A number of previous studies have suggested that elevated preoperative CRP is associated with poor prognosis in colorectal cancer. We aimed to explore the effects of preoperative CRP on colorectal cancer survival through a meta-analysis. A total of 21 studies, including a total of 3934 colorectal cancer patients, were eligible. The multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of selected studies were used to assess the summary estimates of the association between preoperative CRP and colorectal cancer survival. The pooled HRs of elevated preoperative CRP for earlier stage patients were 2.04 (95% CI 1.45-2.86) for OS, 4.37 (95% CI 2.63-7.27) for CSS, and 1.88 (95% CI 0.97-3.67) for DFS. The pooled HRs of a higher Glasgow Prognostic Score (GPS)/modified GPS (mGPS) for earlier stage patients were 2.20 (95% CI 1.61-3.02) for OS and 1.80 (95% CI 1.37-2.37) for CSS. The association between elevated preoperative CRP and poor survival was observed in patients with advanced cancer. Elevated CRP and GPS/mGPS were significantly associated with poor survival. Preoperative CRP and its related markers, GPS and mGPS, were significantly associated with the survival of colorectal cancer surgery patients. The HRs of GPS and mGPS were highly homogeneous across studies for all survival types. Thus, GPS and mGPS may serve as stable predictors of the survival of colorectal cancer surgery patients.

An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients.

Colorectal cancer is still one of the most common causes of cancer related deaths in the world despite improvements in diagnosis and treatment modalities, and application of community-based screening methods. Symptoms of colorectal cancer are non-specific and usually manifest following local progression. A number of patients with advanced stage colorectal cancer present to emergency departments with obstruction as the first sign of disease without any previous symptoms. This presentation is an indication for emergency surgery that has a high rate of morbidity and mortality. In this study, we aimed to determine the factors associated with early diagnosis and survival by comparing postoperative results of colorectal cancer patients who underwent surgery under emergency or elective situation. Files of colorectal patients treated between 2009-2013 were retrospectively analyzed. Data on patient age, gender, operation type, intraoperative results, length of hospital stay, co-morbidities, postoperative complications and pathological results were evaluated and compared. There was no statistical difference between groups in terms of age, gender, and pathology results (p>0.05). The difference between groups in terms of postoperative length of hospital stay, presence of co-morbid diseases, pathological stage, and postoperative complications was statistically significant (p<0.05). Length of hospital stay, advanced stage on admission, complications such as surgical site infection, evisceration, and anastomosis leakage rates were higher in patients in the emergency surgery group. Risk groups should be determined in order to diagnose colorectal cancer patients at an early stage while they are still asymptomatic, and this information should be incorporated into effective screening programs. This approach will be beneficial to treatment outcomes, complication rates, length of hospital stay, and survival and treatment results.

Laparoscopic Surgery for Colorectal Cancer in Korea: Nationwide Data from 2008~2013

The aim of this study was to report nationwide data on the current practice of laparoscopic colorectal cancer (CRC) surgery in Korea. Nationwide surgical data for colorectal cancer from 2008 to 2013 were obtained from the Health Insurance Review & Assessment Service database and a retrospective analysis of CRC surgery patients was conducted. The trends in laparoscopy use for each procedure of colorectal resection over six years were evaluated. From 2008 to 2013, a total of 105,305 patients nationwide underwent resection for CRC, and 55.3% of the cases underwent laparoscopic surgery. The proportion of laparoscopic resection increased from 42.6% in 2008 to 64.7% in 2013. The most common site of colon cancer was sigmoid, followed by ascending, and rectosigmoid junction, which together accounted for 64.9% of all colon cancer cases. The three leading procedures were low anterior resection, hemicolectomy, and anterior resection, which together accounted for 87.3% of all CRCs. For low anterior resection, the rate of laparoscopy increased from 44.8% in 2008 to 69.8% in 2013. The percentage of abdominoperineal resection for rectal cancer continued to decrease from 10.6% in 2008 to 7.5% in 2013. Over the six years, a total of 2520 robotic surgeries for CRC were performed. The number of robotic surgeries for rectal cancer showed a steady increase, whereas that for colon cancer decreased. Overall, the rate of minimally invasive surgeries for CRC was 43.5% in 2008 and increased to 65.7% in 2013. The laparoscopic resection rate for CRC in Korea is very high and continues to show a steady increase.

Impact of previous abdominal surgery on the outcome of laparoscopic resection for colorectal cancer: a case-control study in 756 patients

BackgroundA history of previous abdominal surgery (PAS) may increase the complexity of laparoscopic colorectal surgery. The aim of this study was to investigate the impact of PAS on the outcomes of laparoscopic colorectal resection for colorectal cancer. MethodsA total of 378 colorectal cancer patients (group A) with a history of PAS were 1:1 matched to 378 controls (group B) without PAS from our prospective laparoscopic colorectal surgery database. The two groups were matched for age, gender, body mass index, American Society of Anesthesiology score, tumor location, type of surgical procedure, and tumor stage. ResultsPatients in the two groups were well balanced with respect to baseline demographic and clinical characteristics. Group A was associated with significantly longer median operating time (220 versus 200 min; P = 0.002). Conversion rate in group A (63/378, 16.67%) was almost twice as high as that in group B (36/378, 9.55%; P = 0.004). Conversions caused by adhesion were more common in patients with a history of PAS (55.56% [35/63] versus 27.78% [10/36], P = 0.008). Postoperative recovery time, length of postoperative hospital stay, perioperative mortality and morbidity rate, lymph nodes harvested, circumferential resection margin positive rate, 3-y disease-free survival, and overall survival rate were not significantly different between the two groups. ConclusionsLaparoscopic colorectal surgery for colorectal cancer patients with PAS is time consuming, but the incidence of a successfully completed laparoscopic colorectal resection remains high, and the short- and long-term outcomes are not affected by PAS.

Incidental Cholecystectomy in Patients with Asymptomatic Gallstones Undergoing Surgery for Colorectal Cancer

Background and Aims: The feasibility of incidental cholecystectomy during colorectal cancer (CRC) surgery has not been determined as yet. We aimed to investigate the feasibility of incidental cholecystectomy during CRC surgery. Methods: The clinicopathologic data of patients who underwent CRC surgery between January 2004 and May 2011 were assessed. Patients with asymptomatic cholelithiasis were divided into groups that did and did not undergo incidental cholecystectomy. Their in-hospital morbidity and long-term biliary complications were compared. Results: Of the 282 patients identified, 143 (50.7%) underwent incidental cholecystectomy and 139 (49.3%) were observed without cholecystectomy. The two groups were similar in clinical characteristics, except for gender and operation time. Only one patient (0.7%) in the cholecystectomy group experienced an intraoperative biliary complication. There was no significant difference in overall in-hospital morbidity between the two groups. After a median follow-up period of 33 months, long-term biliary complications developed in 12 patients (8.6%) in the observation group, with 9 undergoing cholecystectomy. Conclusions: Incidental cholecystectomy was not associated with increased postoperative morbidity, whereas previously asymptomatic patients were at substantial long-term risk of becoming symptomatic. Thus, in the absence of clear contraindications, concomitant cholecystectomy might be a desirable treatment option during CRC surgery in patients with asymptomatic gallstones.

Application of fast track surgery in colorectal cancer patients

Application of fast track surgery in colorectal cancer patients

Colorectal Cancer Surgery in Extreme Elderly Population

Background: Colorectal cancer surgery in extreme elderly population (380 years) is a growing problem and a subject in question. Experiences and results in this scenario are limited. Methods: Medical records of patients 380 years old hospitalized in General Surgery Department in Vega Baja Hospital between January 1st 2008 and December 31st 2012 were retrospectively reviewed. Patients diagnosed with colorectal cancer (CRC) were selected. Data regarding comorbidities, treatment performed, complications and survival were collected. Results: 95 patients (74 colon, 21 rectum) were identified: median age 83.0 years (80 - 93), 64.2% males. 93.7% of patients were operated on: median hospital and post-operative stay of 11 and 9 days, respectively; curative intention surgery 82.1%. 4.2% of patients were treated with interventionist procedures, and 2.1% of patients in a conservative way. 17.9% and 4.2% of patients came up with early and late complications, respectively. Early and late mortality occurred in 9.5% and 3.2% of patients, respectively. By March 2014, with a median follow up of 43.8 months, median overall survival for colorectal cancer patients was 2.7 years (95%IC, 2.0 - 3.2). Univariaye Cox Regresion analysis revealed the presence of cardiomyopathy (p = 0.024), the presence of chornic kidney disease (p = 0.025), the presence of comorbidities (vs absence) (0.026), the number of comorbidities (0.034), type of admission (p = 0.001), treatment with surgery (p = 0.001) and the incidence of early (p = 0.004) or late complications (p = 0.023) associated to overall survival with statically significance. Multivariate Cox Regression analysis showed number of comorbidities (HR = 1.104; 95%CI: 0.851 - 1.431; p = 0.456), treatment with surgery (HR = 4.928; 95%CI: 1.815 - 13.385; p = 0.002), programmed admission into hospital (HR = 2.316; 95%CI: 1.298 - 4.133; p = 0.004), and the incidence of late complications (HR = 4.629; 95%CI: 1.279 - 16.750; p = 0.020) independently associated with overall survival. Interaction test between number of comorbidities and early complication was performed (HR = 1.453; 95%CI: 0.971 - 2.175; p = 0.070). Conclusions: In our experience surgery for CRC patients may increase overall survival even in an extreme elderly population (380 years). Nevertheless when considering surgery for CRC in this subgroup of patients, factor such as type of admission into hospital and comorbidities should be taken into account in order to optimize treatment results in the effort to individualize CRC management in this growing population.

297. Multimodal approach to stage IV rectal cancer treatment

297. Multimodal approach to stage IV rectal cancer treatment

298. Cytoreductive surgery in colorectal cancer patients with synchronous lung metastases

298. Cytoreductive surgery in colorectal cancer patients with synchronous lung metastases

Diabetes Is Associated With Socioeconomic Disparities and More Comorbidities in Colorectal Cancer Surgery: A Nationwide Inpatient Sample Study

Introduction: Type 2 diabetes mellitus (T2DM) is associated with an increased risk of colorectal cancer (CRC). Aim is to look at the features and coexisting medical conditions of T2DM patients undergoing CRC surgery. Methods: Retrospective study using discharge data from the 2009 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP). Utilizing ICD-9-CM coding, we analyzed CRC surgery patients with and without T2DM. We excluded patients with type I and secondary diabetes mellitus from our analysis. Results: There were 39 millions admissions in 2009. Presence of T2DM was associated with having more CRC surgeries as opposed to no diabetes (p<0.0001). A total of 100,318 patients with CRC surgery were included, with a mean age of 67.7±0.19 years. Of those, 21,076 (21%) had T2DM. Variables significant on univariate analysis are shown in Table 1 and include non-white males (67 vs. 61%; p<0.0001) with right-sided cancers (54 vs. 51%; p<0.002). Using a multivariate logistic model and after adjusting for significant variables, T2DM and CRC surgery were associated with male gender (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.20, 1.37; p<0.0001), non-white ethnicity (OR 1.35; 95% CI 1.23, 1.47; p<0.0001) and more co-morbid conditions such as hypertension (OR 2.91; 95% CI 2.65, 3.19; p<0.0001), liver disease (OR 1.72; 95% CI 1.33, 2.24; p<0.0001) and congestive heart failure (OR 1.47; 95% CI 1.29, 1.70; p<0.0001).Table 1: Univariate Analysis of Patients With and Without T2DM Undergoing CRC SurgeryConclusion: Patients with T2DM who undergo colon cancer surgeries tend to be non-white males with lower income and more comorbidities. More attention is needed to reduce CRC burden in this group of patients.

A High Body Mass Index (BMI) is Associated With Incremental Health Care Utilization and Surgical Complications in Patients Undergoing Colorectal Cancer Surgery: Presidential Poster

Introduction: Obesity is associated with an increased risk of colorectal cancer (CRC). However, there is a gap in our current knowledge regarding the impact of obesity on CRC surgery. The aim was to look at the impact of obesity and morbid obesity on post-operative outcomes of patients undergoing (CRC) surgery. Methods: Retrospective study using discharge data from the 2009 nationwide inpatient sample (NIS), healthcare cost and utilization project (HCUP). Obesity and morbid obesity were defined using ICD-9-CM codes. We compared CRC surgery patients with and without obesity and their outcomes. Results: There were 105,744 admissions for CRC surgery in 2009 with mean age of 67.7 years. Of those, 8,739 (8.26%) had obesity. Significant variables are shown in table 1 and include female sex, younger age, and African American ethnicity among obese patients. Using a multivariate regression model and after adjusting for significant covariates, obese patients had more underlying comorbidities such as hypertension [odds ratio (OR) 2.70, 95% confidence interval (CI): 2.38-3.13; p<0.0001] and renal failure (OR 2.04, 95% CI: 1.61-2.56; p<0.0001). Obesity was associated with an increased risk of poor surgical wounds healing (OR 4.16, 95% CI: 1.56-11.11; p< 0.0048). Other surgical complications were similar in both groups. By multivariate linear regression, morbidly obese patients who underwent CRC surgery had a longer length of hospital stay (p<0.003), increased total hospital charges of $4,481 (95% CI: 200-8761, p<0.040), and more frequent disposition to short term facilities (skilled nursing facility, intermediate care, or other facility excluding short term hospitals) as opposed to home (OR 2.81, 95% CI 2.17-3.63; p<0.001). Conclusion: Obese patients undergoing CRC surgery tend be younger, African American females, with more comorbid conditions, and an increased risk of surgical complications. Furthermore, presence of morbid obesity is associated with an increment in health care costs. Reducing obesity in the U.S population may not only decrease CRC incidence, but also improve these outcomes in patients admitted for CRC surgery.Table 1

The impact of chronic obstructive pulmonary disease on intensive care unit admission and 30-day mortality in patients undergoing colorectal cancer surgery: a Danish population-based cohort study

Background and purposeChronic obstructive pulmonary disease (COPD) may increase the risk of postoperative complications and thus mortality after colorectal cancer (CRC) surgery, but the evidence is sparse.MethodsWe conducted this nationwide...

Occurrence and Prognosis of Symptomatic Venous Thromboembolism in Colorectal Cancer Surgery Patients.

Purpose:Colorectal cancer (CRC) has a high risk for postoperative thromboembolic complications such as venous thromboembolism (VTE) compared to other surgical diseases, but the relationship between VTE and CRC in Asian patients remains poorly understood. The present study examined the incidence of symptomatic VTE in Korean patients who underwent surgery for CRC. We also identified risk factors, incidence and survival rate for VTE in these patientsMaterials and Methods:The patients were identified from the CRC database treated from January 2011 to December 2012 in a single institution. These patients were classified into VTE and non-VTE groups, their demographic features were compared, and the factors which had significant effects on VTE and mortality between the two groups were analyzed.Results:We analyzed retrospectively a total of 840 patients and the incidence of VTE was 3.7% (31 patients) during the follow-up period (mean, 17.2 months). Histologic subtype (mucinous adenocarcinoma) and previous history of VTE affected the incidence of VTE on multivariate analysis. There was a statistically significant difference in survival rate between the VTE and non-VTE group, but VTE wasn’t the factor affecting survival rate on multivariate analysis. Comparing differences in survival rate for each pathologic stage, there was only a significant difference in stage II patients.Conclusion:Among CRC patients after surgery, the incidence of VTE was approximately 3% within 1 year and development of VTE wasn’t a significant risk factor for death in our study but these findings are not conclusive due to our small sample size.

Genetic variations in the HIF1A gene modulate response to adjuvant chemotherapy after surgery in patients with colorectal cancer.

Hypoxia-inducible factor 1α (HIF-1α) plays an important role in regulating cell survival and angiogenesis, which are critical for tumor growth and metastasis. Genetic variations of HIF1A have been shown to influence the susceptibility to many kinds of human tumors. Increased expression of HIF-1α has also been demonstrated to be involved in tumor progression. However, the prognostic value of single nucleotide polymorphisms (SNPs) in the HIF1A gene remains to be determined in most cancer types, including colorectal cancer (CRC). In this study, we sought to investigate the predictive role of HIF1A SNPs in prognosis of CRC patients and efficacy of chemotherapy. We genotyped two functional SNPs in HIF1A gene using the Sequenom iPLEX genotyping system and then assessed their associations with clinicopathological parameters and clinical outcomes of 697 CRC patients receiving radical surgery using Cox logistic regression model and Kaplan Meier curves. Generally, no significant association was found between these 2 SNPs and clinical outcomes of CRC. In stratified analysis of subgroup without adjuvant chemotherapy, patients carrying CT/TT genotypes of rs2057482 exhibited a borderline significant association with better overall survival when compared with those carrying CC genotype [Hazard ratio (HR), 0.47; 95% confidence interval (95% CI): 0.29-0.76; P < 0.01]. Moreover, significant protective effects on CRC outcomes conferred by adjuvant chemotherapy were exclusively observed in patients carrying CC genotype of rs2057482 and in those carrying AC/CC genotype of rs2301113. Genetic variations in HIF1A gene may modulate the efficacy of adjuvant chemotherapy after surgery in CRC patients.

The effect of the endoscopist on the wait-time for colorectal cancer surgery.

The effect of the specialty of physicians who perform endoscopy on preoperative wait-time of colorectal cancer patients was evaluated. Data from 86 patients who have been operated with a diagnosis of colorectal cancer from January 2011-February 2013 regarding age, sex, tumor location, colonoscopy date, surgery date, the expertise and institution of the endoscopist were retrospectively examined. The time between colonoscopy and surgery was accepted as the pre-operative wait time (PWT). Out of 86 patients, 24 (27.9%) colonoscopies were performed by general surgeons (GS), and 62 (72.1%) by gastroenterologists (GE). When patients who underwent colonoscopy in other centers were extracted, the PWT for our center was 20.4±10.8 days. When grouped according to specialties, the PWT of patients who had their colonoscopy performed by GS was significantly shorter than patients who underwent colonoscopy by GE at the same center (p<0.05). Patient's age, sex and location of the tumor had no effect on PWT (p>0.05). The preparation time for surgery in colorectal cancer patients is influenced by the specialty of the physician performing the procedure. In order to standardize this period, a common flow diagram after endoscopy should be established for patients with suspected malignancy.

Risk factors associated with incisional surgical site infection in colorectal cancer surgery with primary anastomosis

To investigate the incidence of surgical site infection (SSI) and risk factors in colorectal cancer surgery patients. Between October 2003 and October 2013, 1 381 consecutive patients with colorectal cancer managed surgically with primary anastomosis were included in the study. There were 762 male and 619 female patients with mean body mass index (BMI) was (27.7 ± 3.7) kg/m², aged from 20 to 90 years with a median of 67 years. Patients undergoing emergency surgery and requiring stoma creation were excluded. The patients' characteristics, surgical conditions and prognosis were recorded. Univariate and multiple logistic regression analysis were used to identify any variable predictive factors of SSI. One hundred twenty-six (9.12%) cases developed incisional SSI. The occurrence time for SSI was from 2 to 20 days, mean (6.7 ± 2.9) days. According to multivariable logistic regression analysis, BMI (OR = 1.058, P = 0.030), intraoperative contamination (OR = 10.549, P = 0.000) and open operation as compared with a laparoscopic procedure (OR = 2.111, P = 0.001) were significant independent predictors of incisional SSI. There was a significant decrease in incisional SSI in wound protectors group (OR = 1.646, P = 0.012). BMI and intraoperative contamination are independent predictors of incisional SSI, and wound protectors and laparoscopic surgery are associated with a lower incidence of incisional SSI following colorectal cancer surgery.

Morbidity and mortality after colorectal cancer surgery in patients with cirrhosis: A critical review of the literature.

608 Background: Cirrhotic patients with localized colorectal cancer are potential candidates for tumor resection. The aim of this review was to evaluate the morbi-mortality after colorectal surgery. Methods: Comprehensive search was conducted using PUBMED, EMBASE, and the COCHRANE Library. Prospective and retrospective studies were selected. The study population included cirrhotic patients who underwent colorectal resection for non-metastatic colorectal cancer and patients with benign and other malignant disease. The postoperative morbi-mortality and independent risk factors were analysed. Results: Eight studies were identified. Among these, four studies compared the risk of colorectal surgery in patients with and without liver cirrhosis. The number of patients varied from 41 to 6,120. The severity of cirrhosis in most of the studies was classified with the Child-Pugh score. Class B and C were observed in 20% to 60% of the patients. Sepsis represented the main postoperative complication and occurred in 48% to 77% of patients. Mortality varied according to the Child-Pugh score, ranging from 11% to 41%, and was significantly higher for patients with cirrhosis in Child-Pugh Class C. Urgent surgical procedure had a negative impact on prognosis. The average length of hospital stay ranged from 9 to 18 days. Cirrhosis was associated with a 2-3 time and a 4-10 time increased risk of postoperative mortality in the absence and presence of portal hypertension, respectively compared with non-cirrhotic patients. The independent risk factors for postoperative morbidity and mortality were encephalopathy, ascites, low haemoglobin, prolonged prothrombin time, elevated bilirubin, hypoalbuminemia, postoperative infection, total colectomy, elective or non-elective surgery, the presence of co-morbidities and MELD score ≥ 15. Conclusions: Colorectal cancer surgery is associated with an increased risk of postoperative morbidity and mortality in cirrhosis patients. Studies evaluating exclusively the operative risk for colorectal cancer surgery in this patient’s population are rare. Prospective controlled trials to optimize the perioperative management of those patients are needed.

Port Surgery for Colorectal Cancer Patients, Involving the Use of A Single- Incision Laparoscopic Surgery Port at the Planned Stoma Site

A single-incision laparoscopic surgery (SILS) port may be used to reduce the number of surgical incisions. Here, we describe our technique, equivalent in technical difficulty to conventional laparoscopy, of using a SILS port at a planned diverting-stoma site in colorectal cancer patients. This technique is indicated for patients for whom the intent is to perform tumor resection with diverting ileostomy. Because ileostomy is usually created on the right, this technique is most useful for left-sided lesions. However, an additional port in the umbilicus enables dissection of the right colon. The SILS port is placed by the open method, with additional trocars added once pneumoperitoneum is established. One trocar port is eventually used for a drain. We use this technique not only for intersphincteric resection, wherein distal rectal stump stapling is not necessary, but also in total coloproctectomy and ultralow anterior resection, which require deep pelvis stapling or right-sided colonic dissection.