TY - JOUR
T1 - Systematic review with meta-analysis of studies comparing single-incision laparoscopic colectomy and multiport laparoscopic colectomy
AU - Podda, Mauro
AU - Saba, Alessandra
AU - Porru, Federica
AU - Pisanu, Adolfo
PY - 2016/2/23
Y1 - 2016/2/23
N2 - Background: There is currently a paucity of research comparing the clinical outcomes of single-incision laparoscopic colectomy (SILC) with those obtained with multiport laparoscopic colectomy (MLC). This meta-analysis aimed to examine whether SILC shows real benefits over MLC, especially in terms of feasibility, safety, and oncological adequacy. Methods: A literature review of studies comparing SILC and MLC has been performed which looked at the following outcomes: mortality, morbidity, and oncological parameters of adequacy, as well as other potential benefits and drawbacks. Standardized mean difference for continuous variables and odds ratios for qualitative variables were calculated. Results: Thirty studies comparing SILC and MLC were reviewed: two prospective randomized clinical trials (RCTs), eight prospective studies, and 20 retrospective comparative observational studies. Overall, in a cohort of 3502 patients who underwent surgery, SILC was used in 1068 cases (30.5 %) and MLC was used in 2434 cases (69.5 %). Mean intraoperative blood loss was significantly lower when the SILC procedure had been used (75.06 vs. 91.45 ml, P = 0.03); bowel function recovered significantly earlier in the SILC patients (1.96 vs. 2.15 days, P = 0.03); mean postoperative hospital stay was significantly shorter in the SILC group (5.55 vs. 6.60 days, P = 0.0005); and length of skin incision was significantly shorter in SILC patients (3.98 vs. 5.28 cm, P = 0.01). However, in the latter four outcomes, evidence of heterogeneity was found. In contrast, MLC showed significantly better results when compared to SILC in terms of distal free margins (12.26 vs. 10.98 cm, P = 0.01). Conclusions: SILC could be considered as a safe and feasible alternative to MLC in experienced hands. Further evidence for this surgical procedure should be assessed in the form of high-quality RCTs, with additional focus on its use in low rectal cancer resection.
AB - Background: There is currently a paucity of research comparing the clinical outcomes of single-incision laparoscopic colectomy (SILC) with those obtained with multiport laparoscopic colectomy (MLC). This meta-analysis aimed to examine whether SILC shows real benefits over MLC, especially in terms of feasibility, safety, and oncological adequacy. Methods: A literature review of studies comparing SILC and MLC has been performed which looked at the following outcomes: mortality, morbidity, and oncological parameters of adequacy, as well as other potential benefits and drawbacks. Standardized mean difference for continuous variables and odds ratios for qualitative variables were calculated. Results: Thirty studies comparing SILC and MLC were reviewed: two prospective randomized clinical trials (RCTs), eight prospective studies, and 20 retrospective comparative observational studies. Overall, in a cohort of 3502 patients who underwent surgery, SILC was used in 1068 cases (30.5 %) and MLC was used in 2434 cases (69.5 %). Mean intraoperative blood loss was significantly lower when the SILC procedure had been used (75.06 vs. 91.45 ml, P = 0.03); bowel function recovered significantly earlier in the SILC patients (1.96 vs. 2.15 days, P = 0.03); mean postoperative hospital stay was significantly shorter in the SILC group (5.55 vs. 6.60 days, P = 0.0005); and length of skin incision was significantly shorter in SILC patients (3.98 vs. 5.28 cm, P = 0.01). However, in the latter four outcomes, evidence of heterogeneity was found. In contrast, MLC showed significantly better results when compared to SILC in terms of distal free margins (12.26 vs. 10.98 cm, P = 0.01). Conclusions: SILC could be considered as a safe and feasible alternative to MLC in experienced hands. Further evidence for this surgical procedure should be assessed in the form of high-quality RCTs, with additional focus on its use in low rectal cancer resection.
KW - Laparoscopy
KW - Multiport laparoscopic colectomy
KW - Single incision
KW - Single-incision laparoscopic colectomy
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U2 - 10.1007/s00464-016-4812-2
DO - 10.1007/s00464-016-4812-2
M3 - Article
AN - SCOPUS:84959148791
SP - 1
EP - 24
JO - Surgical Endoscopy
JF - Surgical Endoscopy
SN - 0930-2794
ER -