Clinical health service research on single-incision laparoscopic colon and rectal surgery: results of 1,170 patients in a 7-year registry analysis.

Abstract

The clinical impact of single-incision laparoscopic surgery for the colon and rectum remains unclear despite its undeniable advantages. The European Association for Endoscopic Surgery consensus statement in 2019 highlights limitations concerning body mass index, tumor size, and previous surgery based on randomized studies, but many patients fall outside the recommended European Association for Endoscopic Surgery limits. Our study aimed to analyze patient care in routine clinical practice beyond randomized trials to assess its real-world relevance. The development of new robotic platforms for single-port techniques necessitates a reassessment of single-incision laparoscopic surgery applicability in clinics. This analysis is based on a prospectively established multicenter registry database covering data collected over 7 years. Primary endpoints were overall morbidity and mortality; regression analyses identified significant variables. The registry analysis included 1,170 patients from 26 German hospitals performing single-incision laparoscopic colon and/or rectum surgery. Mean operative time was 157.7 minutes; additional trocars were required in 28.3% of cases. The conversion rate was 6.2%. The mean intraoperative complication rate was 1.8%; postoperative complications occurred in 14.9% of cases, and the mortality rate was 0.51%. In multivariate regression analyses, no variable was found to influence intraoperative complications. However, postoperative complications were significantly associated with sex (P < .001) and rectal surgery (P = .028). This registry analysis demonstrates that single-incision laparoscopic surgery for the colon and rectum can be safely performed in routine clinical practice, even outside the selection criteria of European Association for Endoscopic Surgery recommendations. Male sex and rectal surgery significantly increase postoperative complications.