Introduction Conventional laparoscopic surgery for rectal cancer management is now widely accepted as a suitable alternative to open surgery; bestowing specific advantages, without causing detriment to oncological outcome. Evolving from this, single-incision laparoscopic surgery (SILS) has been successfully utilised for the removal of colonic tumours. However, the literature lacks data analysing the suitability of SILS for rectal cancer resection, particularly in terms of oncological outcome. We report medium term oncological outcomes from a prospective observational study of SILS for rectal cancer, including both high and low anterior resections.
Method A prospective electronic database was collated of all patients undergoing SILS rectal cancer resection in our institution, between 2009 and 2014. In addition to patient, tumour and operative data, histo-pathological and medium term oncological outcomes were recorded. Kaplan Meier curves were used to analyse survival, performed using SPSS® Statistics version 21.0 for Windows ® (IBM, Armonk, New York, USA).
Results Sixty-one patients underwent SILS for rectal cancer: high anterior resection (34); Total Mesorectal Excision (TME) (24) and TME with hand sewn colo-anal anastomosis (3). Median operative time was 105 min (37–280 mins) and 92% of cases were completed via SILS. Mean time to diet was 11 h and median length of stay was 2 days (1–8 days).
Median number of lymph nodes harvested was 18 (6–44) and all were R0 resections. After a median follow-up of 46 months (16–64 months), 8 patients developed further disease (13.1%), of whom 5 had liver metastases (8.2%) and 3 developed widespread metastatic disease and local recurrence (4.9%). Three patients have died (4.9%), all of whom had metastases. The mean time to recurrent disease diagnosis was 7 months (2–17months) and post-operative survival of those who died was 29 months, 33 months and 53 months respectively. Kaplan Meier Survival Curves for disease free survival (including local recurrence, metastases and death) are shown in Figure 1.
Conclusion Anterior resection and TME for rectal cancer can be safely performed by the SILS technique, with appropriate histo-pathological results and, crucially, good oncological outcomes. SILS rectal cancer surgery may confer additional advantages over conventional multiport surgery, such as reduced operating time and length of hospital stay.
Disclosure of interest None Declared.
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