Analysis on the short-term outcome of 3-port <i>versus</i> 5-port laparoscopic assisted radical resection for middle and high rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Wensheng ¹ , LIU Xi ^1,2 , HE Shengdong ³ , KANG Zhengyu ^1,2 , CHEN Yijia ^2,4 , HU Xiaoyu ^2,4 , HUANG Wei ^1,2 ,  ZHANG Lin ^1,2,4

1. School of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Gastrointestinal Ward, Center of General Surgery, General Hospital of Western Theater Command of the Chinese People’s Liberation Army, Chengdu 610083, P. R. China;
3. Department of Burn and Plastic Surgery, General Hospital of Western Theater Command of the Chinese People’s Liberation Army, Chengdu 610083, P. R. China;
4. School of Clinical Medicine, Southwest Jiaotong University, Chengdu 610083, P. R. China;

Corresponding?author：

ZHANG Lin, Email: flysky8026@aliyun.com

Keywords：

middle and high rectal cancer; 3-port; 5-port; laparoscopic surgery; short-term outcome

DOI：

10.7507/1007-9424.202004134

Video：

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Objective To compare the short-term outcome of 3-port and 5-port laparoscopic assisted radical resection for middle and high rectal cancer.Methods We retrospectively analyzed the clinical characteristics of 67 patients with middle and high rectal cancer who were treated in the Gastrointestinal Ward of Center of General Surgery in General Hospital of Western Theater Command of the Chinese People’s Liberation Army from January 2018 to December 2018. The operative, pathological, recent postoperative related indicators, and follow-up results of the two groups were compared and analyzed.Results Among all the enrolled patients, 33 cases received 3-port laparoscopic surgery (3-port group) and 34 cases received 5-port laparoscopic surgery (5-port group). The total length of incision and the pain score of the Visual Analog Scale (VAS) on the 3rd postoperative day of the 3-port group were significantly better than those of the 5-port group (P<0.05). Peripheral incisal margins were negative in both two groups. However, there were no statistically significant differences in indicators such as operative time, intraoperative blood loss, operative conversion rate, hospitalization expenses, length of the distal margins, number of positive lymph nodes, number of lymph nodes harvested, time to the first flatus, time to the first ambulation, time to urinary catheter removal, time to drainage tube removal, time to the first oral intake, postoperative hospital stay, and postoperative complication rate (P>0.05). Thirty cases of the 3-port group were followed up for 12–24 months (median of 19 months), as well as 29 cases of 5-port group were followed up for 12–24 months (median of 19.5 months). There were no significant differences on the incidences of intestinal obstruction, local recurrence, distant metastasis, and death between the two groups (P>0.05).Conclusion Compared with the conventional 5-port laparoscopic surgery, the 3-port laparoscopic surgery could shorten the total length of incision and reduce the surgical trauma, suggesting that it is safe and effective.

Citation： YANG Wensheng, LIU Xi, HE Shengdong, KANG Zhengyu, CHEN Yijia, HU Xiaoyu, HUANG Wei, ZHANG Lin. Analysis on the short-term outcome of 3-port versus 5-port laparoscopic assisted radical resection for middle and high rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 43-47. doi: 10.7507/1007-9424.202004134 Copy

1.	趙任, 蔣奕玫. 直腸癌外科手術治療進展. 外科理論與實踐, 2016, 21(6): 468-471.
2.	劉航, 張躍天, 劉震, 等. 腹腔鏡結直腸癌手術與開放性手術的療效及安全性分析. 實用癌癥雜志, 2017, 32(3): 418-420, 424.
3.	Bonjer HJ, Deijen CL, Abis GA, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med, 2015, 372(14): 1324-1332.
4.	Chen K, Cao G, Chen B, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality nonrandomized studies in the last 5 years. Int J Surg, 2017, 39: 1-10.
5.	Hida K, Okamura R, Sakai Y, et al. Open versus laparoscopic surgery for advanced low rectal cancer: a large, multicenter, propensity score matched cohort study in Japan. Ann Surg, 2018, 268(2): 318-324.
6.	遲岳峰. 腹腔鏡結直腸癌根治與傳統根治手術療效的臨床效果對比分析. 中華普外科手術學雜志 (電子版), 2016, 10(2): 130-132.
7.	劉希, 陳詣佳, 黃偉, 等. 減孔腹腔鏡直腸癌根治術臨床研究新進展. 中國普外基礎與臨床雜志, 2018, 25(10): 1270-1275.
8.	Zhang L, Zhang G, Wang P, et al. 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance. Case Rep Clin Med, 2013, 2(7): 386-389.
9.	周鋒, 沙德勝. 單孔、多孔腹腔鏡及開腹手術治療直腸癌的臨床效果對比. 中華普外科手術學雜志 (電子版), 2019, 13(1): 22-24.
10.	Park EJ, Cho MS, Baek SJ, et al. Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg, 2015, 261(1): 129-137.
11.	Guerrieri M, Campagnacci R, Sperti P, et al. Totally robotic vs 3D laparoscopic colectomy: a single centers preliminary experience. World J Gastroenterol, 2015, 21(46): 13152-13159.
12.	Poon JT, Cheung CW, Fan JK, et al. Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc, 2012, 26(10): 2729-2734.
13.	Biebl MO, Schirnhofer J, Weiss HG. Single incision laparoscopic surgery for colorectal cancer. Ann Surg, 2015, 261(1): e17.
14.	呂智豪, 李慧璇, 梁裕琪, 等. 單孔對比傳統腹腔鏡治療結直腸癌療效的 meta 分析. 中國普外基礎與臨床雜志, 2019, 26(8): 964-973.
15.	郭雄飛, 杜建軍, 王園園, 等. 單孔腹腔鏡根治手術治療直腸癌對患者圍術期應激反應的影響. 結直腸肛門外科, 2016, 22(1): 38-41.
16.	宋子甲, 趙任. 單孔腹腔鏡結直腸癌手術研究進展. 中國實用外科雜志, 2019, 39(4): 388-390.
17.	Morales-Conde S, Peeters A, Meyer YM, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc, 2019, 33(4): 996-1019.
18.	Kim CW, Hur H, Min BS, et al. Oncologic outcomes of single-incision laparoscopic surgery for right colon cancer: a propensity score-matching analysis. Int J Surg, 2017, 45: 125-130.
19.	Hirano Y, Hattori M, Douden K, et al. Single-incision plus one port laparoscopic anterior resection for rectal cancer as a reduced port surgery. Scand J Surg, 2012, 101(4): 283-286.
20.	Kawahara H, Watanabe K, Ushigome T, et al. Umbilical incision laparoscopic surgery with one assist port for anterior resection. Dig Surg, 2010, 27(5): 364-366.
21.	張慶彤, 劉亞莉, 張旭, 等. 減孔與多孔腹腔鏡手術治療直腸癌臨床療效對比研究. 中國實用外科雜志, 2017, 37(3): 276-280.
22.	Liu R, Wang Y, Zhang Z, et al. Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery. Surg Endosc, 2017, 31(6): 2437-2450.
23.	劉曉平, 鄧偉, 曾祥福. 改良三孔法與五孔法腹腔鏡直腸癌手術的對比研究. 腹腔鏡外科雜志, 2013, 18(9): 672-675.
24.	劉曉平, 吳平輝, 馮起放, 等. 三孔法腹腔鏡與開腹直腸癌根治術后應激及免疫功能的對比研究. 腹腔鏡外科雜志, 2016, 21(3): 169-172.
25.	王釗, 彭林濤, 許書清. 三孔腹腔鏡對比傳統五孔腹腔鏡用于結直腸癌手術的臨床療效差異性分析. 實用癌癥雜志, 2018, 33(4): 621-624.
26.	曾令春, 陳小鐵, 王熙. 減孔腹腔鏡與 5 孔腹腔鏡直腸癌根治術的臨床療效及預后觀察. 結直腸肛門外科, 2018, 24(2): 137-141.
27.	宋海良, 李亞軍, 王曉琴, 等. 減孔較五孔腹腔鏡對結直腸癌根治性切除術中出血量、淋巴結清掃數目及恢復情況分析. 中華普外科手術學雜志 (電子版), 2017, 11(5): 403-405.

1. 趙任, 蔣奕玫. 直腸癌外科手術治療進展. 外科理論與實踐, 2016, 21(6): 468-471.
2. 劉航, 張躍天, 劉震, 等. 腹腔鏡結直腸癌手術與開放性手術的療效及安全性分析. 實用癌癥雜志, 2017, 32(3): 418-420, 424.
3. Bonjer HJ, Deijen CL, Abis GA, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med, 2015, 372(14): 1324-1332.
4. Chen K, Cao G, Chen B, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality nonrandomized studies in the last 5 years. Int J Surg, 2017, 39: 1-10.
5. Hida K, Okamura R, Sakai Y, et al. Open versus laparoscopic surgery for advanced low rectal cancer: a large, multicenter, propensity score matched cohort study in Japan. Ann Surg, 2018, 268(2): 318-324.
6. 遲岳峰. 腹腔鏡結直腸癌根治與傳統根治手術療效的臨床效果對比分析. 中華普外科手術學雜志 (電子版), 2016, 10(2): 130-132.
7. 劉希, 陳詣佳, 黃偉, 等. 減孔腹腔鏡直腸癌根治術臨床研究新進展. 中國普外基礎與臨床雜志, 2018, 25(10): 1270-1275.
8. Zhang L, Zhang G, Wang P, et al. 3-port incisionless laparoscopic surgery for rectal cancer with a transrectal assistance. Case Rep Clin Med, 2013, 2(7): 386-389.
9. 周鋒, 沙德勝. 單孔、多孔腹腔鏡及開腹手術治療直腸癌的臨床效果對比. 中華普外科手術學雜志 (電子版), 2019, 13(1): 22-24.
10. Park EJ, Cho MS, Baek SJ, et al. Long-term oncologic outcomes of robotic low anterior resection for rectal cancer: a comparative study with laparoscopic surgery. Ann Surg, 2015, 261(1): 129-137.
11. Guerrieri M, Campagnacci R, Sperti P, et al. Totally robotic vs 3D laparoscopic colectomy: a single centers preliminary experience. World J Gastroenterol, 2015, 21(46): 13152-13159.
12. Poon JT, Cheung CW, Fan JK, et al. Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc, 2012, 26(10): 2729-2734.
13. Biebl MO, Schirnhofer J, Weiss HG. Single incision laparoscopic surgery for colorectal cancer. Ann Surg, 2015, 261(1): e17.
14. 呂智豪, 李慧璇, 梁裕琪, 等. 單孔對比傳統腹腔鏡治療結直腸癌療效的 meta 分析. 中國普外基礎與臨床雜志, 2019, 26(8): 964-973.
15. 郭雄飛, 杜建軍, 王園園, 等. 單孔腹腔鏡根治手術治療直腸癌對患者圍術期應激反應的影響. 結直腸肛門外科, 2016, 22(1): 38-41.
16. 宋子甲, 趙任. 單孔腹腔鏡結直腸癌手術研究進展. 中國實用外科雜志, 2019, 39(4): 388-390.
17. Morales-Conde S, Peeters A, Meyer YM, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc, 2019, 33(4): 996-1019.
18. Kim CW, Hur H, Min BS, et al. Oncologic outcomes of single-incision laparoscopic surgery for right colon cancer: a propensity score-matching analysis. Int J Surg, 2017, 45: 125-130.
19. Hirano Y, Hattori M, Douden K, et al. Single-incision plus one port laparoscopic anterior resection for rectal cancer as a reduced port surgery. Scand J Surg, 2012, 101(4): 283-286.
20. Kawahara H, Watanabe K, Ushigome T, et al. Umbilical incision laparoscopic surgery with one assist port for anterior resection. Dig Surg, 2010, 27(5): 364-366.
21. 張慶彤, 劉亞莉, 張旭, 等. 減孔與多孔腹腔鏡手術治療直腸癌臨床療效對比研究. 中國實用外科雜志, 2017, 37(3): 276-280.
22. Liu R, Wang Y, Zhang Z, et al. Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery. Surg Endosc, 2017, 31(6): 2437-2450.
23. 劉曉平, 鄧偉, 曾祥福. 改良三孔法與五孔法腹腔鏡直腸癌手術的對比研究. 腹腔鏡外科雜志, 2013, 18(9): 672-675.
24. 劉曉平, 吳平輝, 馮起放, 等. 三孔法腹腔鏡與開腹直腸癌根治術后應激及免疫功能的對比研究. 腹腔鏡外科雜志, 2016, 21(3): 169-172.
25. 王釗, 彭林濤, 許書清. 三孔腹腔鏡對比傳統五孔腹腔鏡用于結直腸癌手術的臨床療效差異性分析. 實用癌癥雜志, 2018, 33(4): 621-624.
26. 曾令春, 陳小鐵, 王熙. 減孔腹腔鏡與 5 孔腹腔鏡直腸癌根治術的臨床療效及預后觀察. 結直腸肛門外科, 2018, 24(2): 137-141.
27. 宋海良, 李亞軍, 王曉琴, 等. 減孔較五孔腹腔鏡對結直腸癌根治性切除術中出血量、淋巴結清掃數目及恢復情況分析. 中華普外科手術學雜志 (電子版), 2017, 11(5): 403-405.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis on the short-term outcome of 3-port versus 5-port laparoscopic assisted radical resection for middle and high rectal cancer

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