title: Assessment of treatment options for rectosigmoid cancer: single-incision plus one port laparoscopic surgery, single-incision laparoscopic surgery, and conventional laparoscopic surgery.
abstract: The advantages of reduced-port laparoscopic surgery (RPLS) for rectosigmoid cancer treatment have been disputed. This study evaluated the outcomes of RPLS compared to conventional laparoscopic surgery (CLS) for rectosigmoid cancer.
  
  
  
  Data from 211 patients who underwent a selective sigmoidectomy or anterior resection from August 2011 to June 2014 at a single institution were collected and analyzed via propensity score matching. Operative outcomes, inflammatory responses, pain intensity, oncologic outcomes, quality of life, and cosmetic results were compared between groups.
  
  
  
  After matching, 96 patients (48 CLS and 48 RPLS) were evaluated. Sixteen RPLS cases underwent single-incision laparoscopic surgery (SILS), and 32 underwent single-incision plus one port laparoscopic surgery (SILS + 1). Baseline clinical characteristics were comparable between the RPLS and the CLS groups. Morbidity, pathologic outcomes, and 3-year disease-free survival and overall survival rates were also comparable between the 2 groups. Compared with the CLS group, the RPLS group had a shorter total incision length (p < 0.001); shorter time to liquid diet (p = 0.027), ambulation (p = 0.026), and discharge (p < 0.001); and lower visual analogue scale scores during mobilization at postoperative days 3-5 (p < 0.05). The total operation times, C-reactive protein levels at 24 h and 96 h, and interleukin-6 levels at 24 h postoperatively were significantly lower in the SILS + 1 group than those in the CLS and SILS groups (p < 0.05). Compared with the CLS group, the RPLS group showed better social functioning at 6 months postoperatively (p = 0.011). The SILS and SILS + 1 groups showed similar cosmetic results, and both groups showed better results than the CLS group (p < 0.001).
  
  
  
  RPLS for rectosigmoid cancer is feasible, with short-term safety and long-term oncological safety comparable to that of CLS. Better cosmesis and accelerated recovery can be expected. SILS + 1 is a better choice than CLS or SILS for rectosigmoid cancer because it minimizes invasiveness and reduces technical difficulties.
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China.|Department of Gynecological Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.|Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.|Tianjin's Clinical Research Center for Cancer, Tianjin, China.
authors.forename: Ruoyan
authors.initials: R
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China.
authors.forename: Yanan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China.|Department of Head and Neck Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China.|Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.|Tianjin's Clinical Research Center for Cancer, Tianjin, China.
authors.forename: Ze
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China.
authors.forename: Liying
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China. navyd999@163.com.
authors.forename: Haijun
authors.initials: H
authors.lastname: Deng
authors.affiliation: Department of General Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, 510-515, Guangzhou, China. gzliguoxin@163.com.
authors.forename: Guoxin
authors.initials: G
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012004:Rectal Neoplasms / Q000601:surgery*; D012811:Sigmoid Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Colorectal cancer; Cosmesis; Inflammatory responses; Propensity score; Rectosigmoid; Single-incision laparoscopic surgery