title: Short-term and long-term outcomes of single-incision versus multi-incision laparoscopic resection for colorectal cancer: a propensity-score-matched analysis of 214 cases.
abstract: BACKGROUND
  The aim of this study was to reveal the short-term and long-term outcomes of single-incision laparoscopic colorectal resection (SILC) compared with multi-incision laparoscopic colorectal resection (MILC) for colorectal cancer using propensity score matching analysis.
  
  
  METHODS
  The study group included 235 patients who underwent SILC and 730 patients who underwent MILC for colorectal cancer between April 2009 and September 2014. The propensity score matching for age, gender, body mass index, tumor location (right-sided colon/sigmoid colon/upper rectum), lymph node dissection (D1/D2/D3), pathologic T (≤T3) stage and TNM (0-I/II/III) stage produced 107 matched pairs. The exclusion criteria for SILC were as follows: (1) tumors located at the transverse, descending colon or lower rectum, (2) stage IV tumors, synchronous or previous malignancies, (3) locally advanced tumors >T4, (4) acute obstructions or previous major abdominal surgery and (5) obese patients: BMI > 30.
  
  
  RESULTS
  No significant differences were observed in operating time, bleeding volumes, starting time of liquid diet and length of hospital stay between the SILC and MILC groups. However, the SILC group showed less analgesic requirements (1.1 vs. 1.9 times; p = 0.0006) and shorter length of incision (2.7 vs. 4.3 cm; p = 0.0000) compared to MILC group. The overall rate of postoperative complications was similar in both groups (2.8 vs. 3.7%, p = 0.70). The 5-year overall survival rate of SILC and MILC was 100 and 95% (p = 0.125) and 5-year disease-free survival rates in stages 0-III were 97 and 94% (p = 0.189), 100 and 92% in stage II and 90 and 85% in stage III, respectively.
  
  
  CONCLUSIONS
  This study suggests that SILC for colorectal cancer is a safe and feasible option with better cosmetic results and less pain in strictly selected patients. SILC can also produce good oncological results with similar postoperative outcomes to MILC.
authors.affiliation: Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, 279-0021, Japan. gkatsuno4596@sd5.so-net.ne.jp.
authors.forename: Goutaro
authors.initials: G
authors.lastname: Katsuno
authors.affiliation: Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, 279-0021, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Fukunaga
authors.affiliation: Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, 279-0021, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Nagakari
authors.affiliation: Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, 279-0021, Japan.
authors.forename: Seichiro
authors.initials: S
authors.lastname: Yoshikawa
authors.affiliation: Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, 279-0021, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Azuma
authors.affiliation: Department of Surgery, Juntendo Urayasu Hospital, Juntendo University, 2-1-1 Tomioka, Urayasu, 279-0021, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kohama
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D016555:Matched-Pair Analysis; D057216:Propensity Score; D012189:Retrospective Studies
chemical_list: D000700:Analgesics
keywords: Colon cancer; Propensity score; Rectal cancer; Single-incision laparoscopic surgery