Two-port vs four-port laparoscopic resection for colorectal cancer: Efficacy and outcomes

Abstract

BACKGROUND

In the current laparoscopic surgery practice of colorectal cancer (CRC), the four-port technique is more traumatic, whereas the single-port surgery is associated with technical difficulty and a limited field of view. Thus, the two-port technique, which is less traumatic and more feasible, becomes increasingly significant in clinical practice.

AIM

To compare the clinical effects of two-port and four-port laparoscopic techniques for CRC treatment.

METHODS

In the review of the medical records of patients with CRC from March 2022 to March 2025, 80 cases of two-port laparoscopic radical resection (two-port group) and 70 cases of four-port laparoscopic resection (four-port group) were identified for direct surgical comparison. These groups were evaluated and compared for surgical indicators (surgical duration, total intraoperative hemorrhage, and total length of incision), postoperative recovery (time to first flatus/ambulation, and total hospitalization duration), postoperative complications (ileus, anastomotic fistula, surgical site infection, bleeding, uroschesis, and intraperitoneal abscess), gastrointestinal function (gastrin and motilin), oncological indices (carcinoembryonic antigen, cytokeratin 19 fragment antigen 21-1, and carbohydrate antigen 125), and humoral immunity [immunoglobulin (Ig) A/G/M].

RESULTS

The two-port and four-port groups were comparable in terms of operation time and total intraoperative bleeding. However, the two-port group showed lower values with respect to the total incision length, time to flatus/ambulation, hospitalization time, and overall complications. Gastrin and motilin levels were reduced from baseline in the two-port group but were still higher than those in the four-port group. Carcinoembryonic antigen, cytokeratin 19 fragment antigen 21-1, and carbohydrate antigen 125 levels were lower, whereas IgA, IgG, and IgM values were higher postoperatively in the two-port group than those in the four-port group.

CONCLUSION

Compared with patients with CRC who underwent four-port laparoscopic surgery, those who underwent two-port laparoscopic resection recovered faster and were fairly safe. In addition, the gastrointestinal hormone disturbance was relatively mild, the serum tumor markers were significantly reduced, and the humoral immune response was enhanced.

Keywords: Two-port technique; Four-port technique; Laparoscopic radical resection; Colorectal cancer; Clinical outcomes

Core Tip: This study compares the efficacy of two-port with that of four-port laparoscopic radical resection of colorectal cancer. The two-port approach shows clinical superiority, with reduced total incision length, quicker postoperative recovery, fewer total complications, and better gastrointestinal/humoral immune functions. The results can provide better surgical treatment options for patients with colorectal cancer.