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Objective: The aim of this study was to evaluate the long-term outcomes that were the secondary endpoints of a RCT of multi-port laparoscopic colectomy (MPC) versus SILC in colon cancer surgery., Summary of Background Data: The actual long-term outcomes, such as the 5-year RFS, OS, and recurrence patterns after surgery, have not been evaluated by a RCT., Methods: Patients with histologically proven colon carcinoma located in the cecum, ascending, sigmoid or rectosigmoid colon clinically diagnosed as stage 0-III were eligible for this study. Patients were preoperatively randomized and underwent complete mesocolic excision. The 5-year RFS, OS, and recurrence patterns were analyzed (UMIN-CTR 000007220)., Results: Between March 1, 2012, and March 31, 2015, a total of 200 patients were randomly assigned to either the MPC arm (n = 100) or SILC arm (n = 100). The median follow-up for all patients was 61.0 months. An intention-to-treat analysis showed that the 5-year RFS was 91.0% [95% confidence interval (CI) 85.1%-96.9%] in the MPC arm and 88.0% (95% CI 82.1%-93.9%) in the SILC arm (hazard ratio: 1.37; 95% CI 0.58-3.24; P = 0.479). The 5-year OS was 95.0% (95% CI 91.1%-98.9%) in the MPC arm and 93.0% (87.1%-98.9%) in the SILC arm (hazard ratio: 1.39; 95% CI 0.44-4.39; P = 0.568). There were no significant differences in the recurrence patterns between the 2 arms., Conclusions: Even though the results of the 5-year OS and RFS in this trial were exploratory and underpowered, there were no statistically significant differences between the SILC and MPC arms. SILC may be an acceptable treatment option for select patients with colon cancer., Competing Interests: Jun Watanabe, Atsushi Ishibe, Hirokazu Suwa, Mitsuyoshi Ota, Shoichi Fujii, Kazumi Kubota, Chikara Kunisaki, and Itaru Endo have no conflicts of interest or financial ties to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The efficacy and safety of single-incision laparoscopic colectomy (SILC) for colonic cancer remain unclear. The aim of this study was to determine the outcomes of SILC compared with multiport laparoscopic colectomy (MPLC) for colonic cancer., Methods: Patients with histologically proven colonic carcinoma located in the caecum, ascending, sigmoid or rectosigmoid colon, clinically diagnosed as stage 0-III by CT, were eligible for this study. Patients were randomized before surgery and underwent tumour dissection with complete mesocolic excision. Safety analyses were conducted according to randomization groups., Results: A total of 200 patients were enrolled and randomized to the MPLC (100 patients) or SILC (100 patients) arm. Surgical outcomes were similar between the MPLC and SILC arms, including duration of operation (mean 162 versus 156 min respectively; P = 0·273), blood loss (mean 8·8 versus 21·4 ml; P = 0·102), conversion to open laparotomy (2·0 versus 1·0 per cent; P = 0·561), reoperation (3·0 versus 3·0 per cent; P = 1·000), time to first flatus (both median 1 day; P = 0·155) and postoperative hospital stay (both median 6; P = 0·372). The total skin incision length was significantly shorter in the SILC arm (mean 4·4 cm versus 6·8 cm in the MPLC arm; P < 0·001). The median duration of analgesia use was 5 days in the MPLC and 4 days in the SILC arm (P = 0·485). Overall complication rates were equivalent (15·0 versus 12·0 per cent respecitvely; P = 0·680)., Conclusion: SILC is not superior to MPLC., Registration Number: UMIN000007220 (http://www.umin.ac.jp/ctr/index.htm)., (© 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.)

Background/aims: This study assessed the short term results of laparoscopic colorectal resection for high risk patients., Methodology: Five hundred and fifty seven consecutive patients underwent an elective laparoscopic colorectal cancer resection by the same surgical team between April 2007 and December 2010. No risk patients in ASA class 1 (Group N, n=222), low risk patients with the systemic disease under the control in ASA class 2 and 3 (Group L, n=320), high risk patients with severe comorbidities in ASA class 4 (Group H, n=15) were respectively compared., Results: The median blood loss count was significantly higher than the other group (N: 26 g, L: 22 g) in group H (59 g; p<0.05). On the other hands, the less lymphadenectomy was performed and a reconstruction with anastomosis was denied in group H. The incidence of postoperative complications was not significantly different in each group (N: 12%, L: 18%, H: 26%; p>0.05). There was the significant difference of the incidence with systemic complication (respiratory failure, ascites and delirium) in group H. The median postoperative hospital stay was not significantly different in each group (POD7; p>0.05). Hospitalization death occurred in three patients (0.5%) by uncontrollability of the systemic disease, two patients in group L and one patient in group H., Conclusions: Laparoscopic colorectal resection for high risk patients was performed safely without increasing complications and postoperative hospital stay.

Background: Laparoscopic colectomy for colorectal cancer has become established as a minimally invasive surgical approach. However, many disposable instruments are required, and there is an associated disadvantage of cost. We have developed a new technique, which uses a suture string to lift up the colon. This method is expected to reduce the number of access ports required without compromising the radical cure., Operative Procedure: A suture string piercing the abdominal wall is passed through the mesocolon. The colon is retracted anteriorly and is fixed at the abdominal wall. The main mesenteric vessels are under tension, and lymph node dissection is performed easily by a medial approach. The working space is more stable because the colon is fixed to the abdominal wall., Methods: This study examined the short-term and long-term surgical outcomes of laparoscopic resection for colorectal cancer using our colon lifting-up technique (CLT), compared with the standard multiport technique. The study design was a case-matched control by propensity scoring. Analyzed variables were sex, age, American Society of Anesthesiologists score, cancer in a different organ, multiple colorectal cancer, operator, operative year, tumor location, operative procedure, adjuvant chemotherapy, and International Union Against Cancer TNM stage., Results: From 2000 to 2010, 301 patients underwent CLT and 436 standard multiport technique, 148 patients were matched by propensity score and analyzed. Regarding short-term outcomes, there was no difference between the 2 groups. The mean number of ports needed was 3.37±0.48 for CLT (93 with 3 ports, 55 with 4). There were no differences in recurrence-free survival and overall survival in long-term follow-up results for each stage. There were neither recurrences nor complications due to CLT., Conclusions: The CLT facilitated laparoscopic colectomy without compromising cure rates. It is a useful method to keep a stable view and to conserve medical resources.

A new intracorporeal suture-less stapled end-to-end anastomosis in laparoscopic left-colectomy for colon cancer - a video vignette I Dear Editor i , In many retrospective studies and two randomized controlled trials, intracorporeal anastomosis in laparoscopic colon cancer surgery compared with extracorporeal anastomosis has shown advantages such as less pain due to decreased wound length, earlier recovery of postoperative bowel function and reduced short-term morbidity [1-4]. Even though the use of barbed sutures has reduced the entry hole closure time and the whole anastomotic time considerably [9], a suture-less stapled end-to-end anastomosis can be a promising anastomotic technique to solve some of these problems. [Extracted from the article]