Meta-analysis of Randomized Controlled Trials Only Exploring the Role of Single Incision Laparoscopic Surgery Versus Conventional Multiport Laparoscopic Surgery for Colorectal Resections

Overview

Journal Transl Gastroenterol Hepatol

Publisher AME Publishing Company

Specialty Gastroenterology

Date 2018 Jul 5

PMID 29971261

Citations 3

Authors

Madhusoodhana Hebbar

Waleed Riaz

Parv Sains

Mirza Khurrum Baig

Muhammad Shafique Sajid

Affiliations

Soon will be listed here.

Abstract

Background: The objective of this article is to evaluate the surgical outcomes in patients undergoing single incision laparoscopic surgery (SILS) versus conventional multi-incision laparoscopic surgery (MILS) for colorectal resections.

Methods: The data retrieved from the published randomized controlled trials (RCTs) reporting the surgical outcomes in patients undergoing SILS versus MILS for colorectal resections was analysed using the principles of meta-analysis. The combined outcome of dichotomous data was represented as risk ratio (RR) and continuous data was shown as standardized mean difference (SMD).

Results: Five RCTs on 525 patients reported the colorectal resections by SILS versus MILS technique. In the random effects model analysis using the statistical software Review Manager 5.3, the operation time (SMD, 0.20; 95% CI, -0.11 to 0.52; z=1.28; P=0.20), length of in-patient stay (SMD, -0.18; 95% CI, -0.51 to 0.14; z=1.10; P=0.27) and lymph node harvesting (SMD, 0.09; 95% CI, -0.14 to 0.33; z=0.76; P=0.45) were comparable between both techniques. Furthermore, post-operative complications (RR, 1.00; 95% CI, 0.65-1.54; z=0.02; P=0.99), post-operative mortality, surgical site infection rate (RR, 3.00; 95% CI, 0.13-70.92; z=0.68; P=0.50), anastomotic leak rate (RR, 0.43; 95% CI, 0.11-1.63; z=1.24; P=0.21), conversion rate (P=0.13) and re-operation rate (P=0.43) were also statistically similar following SILS and MILS.

Conclusions: SILS failed to demonstrate any superiority over MILS for colorectal resections in all post-operative surgical outcomes.

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References

Bucher P, Pugin F, Morel P . Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis. 2008; 23(10):1013-6. DOI: 10.1007/s00384-008-0519-8. View

Veldkamp R, Kuhry E, Hop W, Jeekel J, Kazemier G, Bonjer H . Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005; 6(7):477-84. DOI: 10.1016/S1470-2045(05)70221-7. View

Fleshman J, Sargent D, Green E, Anvari M, Stryker S, Beart Jr R . Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007; 246(4):655-62. DOI: 10.1097/SLA.0b013e318155a762. View

Fung A, Aly E . Systematic review of single-incision laparoscopic colonic surgery. Br J Surg. 2012; 99(10):1353-64. DOI: 10.1002/bjs.8834. View

Buunen M, Veldkamp R, Hop W, Kuhry E, Jeekel J, Haglind E . Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol. 2008; 10(1):44-52. DOI: 10.1016/S1470-2045(08)70310-3. View

Nelson H, Sargent D, Wieand H, Fleshman J, Anvari M, Stryker S . A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004; 350(20):2050-9. DOI: 10.1056/NEJMoa032651. View

Schwenk W, Bohm B, Haase O, Junghans T, Muller J . Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg. 1998; 383(1):49-55. DOI: 10.1007/s004230050091. View

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Warner E, Crighton E, Moineddin R, Mamdani M, Upshur R . Fourteen-year study of hospital admissions for diverticular disease in Ontario. Can J Gastroenterol. 2007; 21(2):97-9. PMC: 2657668. DOI: 10.1155/2007/943460. View

10.

Hoyuela C, Juvany M, Carvajal F . Single-incision laparoscopy versus standard laparoscopy for colorectal surgery: A systematic review and meta-analysis. Am J Surg. 2017; 214(1):127-140. DOI: 10.1016/j.amjsurg.2017.03.002. View

11.

Kang B, Park S, Lee K, Lee S . Single-Port Laparoscopic Surgery Can Be Performed Safely and Appropriately for Colon Cancer: Short-Term Results of a Pilot Randomized Controlled Trial. J Laparoendosc Adv Surg Tech A. 2017; 27(5):501-509. DOI: 10.1089/lap.2016.0467. View

12.

CHALMERS T, SMITH Jr H, Blackburn B, Silverman B, Schroeder B, Reitman D . A method for assessing the quality of a randomized control trial. Control Clin Trials. 1981; 2(1):31-49. DOI: 10.1016/0197-2456(81)90056-8. View

13.

Kang B, Kim H, Kye B, Lee S, Lee K, Park S . Multicenter, randomized single-port versus multiport laparoscopic surgery (SIMPLE) trial in colon cancer: an interim analysis. Surg Endosc. 2017; 32(3):1540-1549. DOI: 10.1007/s00464-017-5842-0. View

14.

Ramos-Valadez D, Ragupathi M, Nieto J, Patel C, Miller S, Pickron T . Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series. Surg Endosc. 2011; 26(1):96-102. DOI: 10.1007/s00464-011-1833-8. View

15.

Kim S, Ryu G, Choi B, Kim J, Lee K, Lee S . The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg. 2011; 254(6):933-40. DOI: 10.1097/SLA.0b013e318237826b. View

16.

Antoniou S, Koch O, Antoniou G, Lasithiotakis K, Chalkiadakis G, Pointner R . Meta-analysis of randomized trials on single-incision laparoscopic versus conventional laparoscopic appendectomy. Am J Surg. 2013; 207(4):613-22. DOI: 10.1016/j.amjsurg.2013.07.045. View

17.

Laurent C, Leblanc F, Wutrich P, Scheffler M, Rullier E . Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg. 2009; 250(1):54-61. DOI: 10.1097/SLA.0b013e3181ad6511. View

18.

Guillou P, Quirke P, Thorpe H, Walker J, Jayne D, Smith A . Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005; 365(9472):1718-26. DOI: 10.1016/S0140-6736(05)66545-2. View

19.

Chew M, Wong M, Lim B, Ng K, Eu K . Evaluation of current devices in single-incision laparoscopic colorectal surgery: a preliminary experience in 32 consecutive cases. World J Surg. 2011; 35(4):873-80. DOI: 10.1007/s00268-011-0989-7. View

20.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View