Ann Coloproctol.  2015 Feb;31(1):16-22. 10.3393/ac.2015.31.1.16.

Reduced-Port Laparoscopic Surgery for a Tumor-Specific Mesorectal Excision in Patients With Colorectal Cancer: Initial Experience With 20 Consecutive Cases

Affiliations
  • 1Division of Colorectal Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
  • 2Division of Colorectal Surgery, Department of Surgery, Colorectal Cancer Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. hhyuk@yuhs.ac

Abstract

PURPOSE
Single-port plus one-port, reduced-port laparoscopic surgery (RPLS) may decrease collisions between laparoscopic instruments and the camera in a narrow, bony, pelvic cavity while maintaining the cosmetic advantages of single-incision laparoscopic surgery. The aim of this study is to describe our initial experience with and to assess the feasibility and safety of RPLS for tumor-specific mesorectal excisions (TSMEs) in patients with colorectal cancer.
METHODS
Between May 2010 and August 2012, RPLS for TSME was performed in 20 patients with colorectal cancer. A single port with four channels through an umbilical incision and an additional port in the right lower quadrant were used for RPLS.
RESULTS
The median operation time was 231 minutes (range, 160-347 minutes), and the estimated blood loss was 100 mL (range, 50-500 mL). We transected the rectum with one laparoscopic stapler in 17 cases (85%). The median time to soft diet was 4 days (range, 3-6 days), and the length of hospital stay was 7 days (range, 5-45 days). The median total number of lymph nodes harvested was 16 (range, 7-36), and circumferential resection margin involvement was found in 1 case (5%). Seven patients (35%) developed postoperative complications, and no mortalities occurred within 30 days. During the median follow-up period of 20 months (range, 12-40 months), liver metastasis occurred in 1 patient 10 months after surgery, and local recurrence was nonexistent.
CONCLUSION
RPLS for TSME in patients with colorectal cancer is technically feasible and safe without compromising oncologic safety. However, further studies comparing RPLS with a conventional, laparoscopic low-anterior resection are needed to prove the advantages of the RPLS procedure.

Keyword

Rectal neoplasms; Natural orifice endoscopic surgery; Laparoscopy

MeSH Terms

Colorectal Neoplasms*
Diet
Follow-Up Studies
Humans
Laparoscopy*
Length of Stay
Liver
Lymph Nodes
Mortality
Natural Orifice Endoscopic Surgery
Neoplasm Metastasis
Postoperative Complications
Rectal Neoplasms
Rectum
Recurrence
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