Comparison of clinical outcomes of single-incision versus multi-port laparoscopic surgery for rectosigmoid or upper rectal cancer

Background: The clinical impact of single-incision laparoscopic surgery (SILS) for rectal cancer is unclear. However, SILS is a technically challenging procedure for novice surgeons. The aim of this study was to evaluate clinical outcomes of SILS for rectal cancer compared with multi-port laparoscopic surgery (MPLS). Patients and Methods: We retrospectively analyzed 357 consecutive patients with stage I–III rectal cancer located in the rectosigmoid or upper rectum who underwent SILS or MPLS between January 2012 and December 2016, using propensity score-matched analysis. Results: : After propensity score-matching, we enrolled 204 patients (n=102 per group). Before matching, significant group-dependent differences were observed in tumor location (p < 0.001). After matching, preoperative clinical factors were similar between groups. SILS was successful in 73.5% of cases, an additional port was required in 23.5% and 2.9% were converted to open surgery. Compared to the MPLS group, the SILS group showed shorter operative time (192 vs. 211 min, p=0.015) and shorter postoperative hospital stay (9 vs. 11 days, p=0.038). Other operative factors and morbidity rates did not differ significantly between groups. The number of harvested lymph nodes was smaller in the SILS group (24) than in the MPLS group (27, p=0.008). Postoperative recurrence did not differ between groups before or after matching. No significant differences in 3-year disease-free, 3-year local recurrence-free or 5-year overall survival were found between groups. Conclusions: : SILS is safe, feasible and offers satisfactory oncological outcomes in selected patients with rectosigmoid or upper rectal cancer.