Single-incision laparoscopy versus standard laparoscopy for colorectal surgery: A systematic review and meta-analysis

The aim of this meta-analysis was to evaluate if the advantages of single-incision laparoscopic surgery (SILS) to perform a colorectal resection justify a broad application of this approach. A total of 32 studies including 3863 patients, comparing colorectal procedures performed with SILS or multi-port laparoscopy (LCS) were analyzed after a systematic review. Colorectal SILS had comparable outcomes to multi-port LCS in terms of operating time (P = 0.44), conversion rate (2.0% vs 3.0%; P = 0.52), reoperations (1.1% vs 1.7%; P = 0.26), postoperative complications (14.4% vs 13.6%; P = 0.10) and mortality (0.24% vs 0.68%; P = 0.46). Mean hospital stay was significantly shorter in CSILS group, (MD = -0.88 [-1.33, -0,42], 95% CI, P = 0.0001), but heterogeneity was found (I² = 65%; P < 0.0001). The oncological results of SILS for colorectal cancer were satisfactory, as demonstrated by similar average lymph node retrieval (P = 0.72) and adequate resection margins (negative in all cases) compared to those obtained with LCS. Nevertheless, there are currently no available long-term follow-up data comparing the survival rates and local recurrence between both approaches. Insufficient data were available for evaluating long-term incisional hernia rates, and other potential benefits associated with colorectal SILS (cosmesis, postoperative pain) remain to be objectively proved. To date there is insufficient evidence to recommend widespread use of SILS instead of LCS for colorectal surgery.