Discussion
postoperative pain, cancer, sigmoid colon cancer, colon cancer, rectosigmoid cancer
COLORECTAL CANCER, RECURRENCE, CANCER, SIGMOID COLON CANCER, COLON CANCER, SILS, RECTAL CANCER, COMPLICATIONS
This randomized clinical trial conducted at Nanfang Hospital in China among patients with rectosigmoid cancer (clinical stage T1-4aN0-2M0), found that the 3-year disease-free survival and 5-year overall survival of patients assigned to the SILS + 1 group was not inferior to that of patients assigned to the CLS group. Additionally, no significant differences were found between the groups in the pattern of recurrence over the 5-year period.Compared with CLS, SILC has been shown to achieve less postoperative pain, better cosmetic effect and lower risk for surgical site complications. Despite the encouraging results, SILC has not been widely adopted due to the technical challenges, including conflicts of surgical devices, loss of triangulation, in-line viewing and a significant learning curve distinct from traditional laparoscopy [Besides the favorable short-term outcomes, long-term oncological outcome is another important measurement for a new surgical technique in the field of radical cancer resection. Previously published observational studies and similar-scale randomized trials [Although the purpose of this study was to compare the effectiveness of SILS + 1 and CLS for colorectal cancer, we found 5-year OS rates and 3-years DFS rates of this present study were lower than those of other previously published studies. Watanabe et al [This study has several limitations. First, we only enrolled patients with sigmoid colon cancer or upper rectal cancer and therefore applying SILS + 1 for patients with other different site of colon cancer needs to be verified through other clinical trials. Second, although the possibility of allocation bias was reduced using random principle, loss of follow-up after operation might have affected this study. Third, this trial was a single-institutional RCT, the number of cases was limited because the sample size was calculated based on the early morbidity rate. Thus, a further prospective multi-institution RCT with larger number of patients will be required to confirm the long-term survival of SILS + 1 and whether or not SILS + 1 is indeed a viable alternative strategy to CLS for colorectal cancer.