Reduced‐Port Versus Multi‐Port Laparoscopic Colectomy for Colorectal Cancer: A Systematic Review, Meta‐Analysis, and Meta‐Regression

Abstract

ABSTRACT Background Reduced‐port laparoscopic colectomy (RPLC) has emerged as an alternative to multi‐port laparoscopic colectomy (MPLC) for colorectal cancer surgery, aiming to reduce operative morbidity and improve cosmetic outcomes. This systematic review and meta‐analysis evaluated and compared operative, postoperative, and oncologic outcomes between RPLC and MPLC. Methods Following PRISMA guidelines, we systematically searched PubMed, Cochrane Library, ScienceDirect, and Google Scholar from inception to June 2025. The protocol was registered on PROSPERO (CRD420251078328). Included studies were randomized controlled trials (RCTs) or cohort studies comparing RPLC and MPLC. Primary outcomes were estimated blood loss, operative time, hospital stay, lymph node yield, and postoperative recovery indicators. Secondary outcomes included conversion rates, complications, and Clavien‐Dindo graded adverse events. Risk of bias was evaluated using the Newcastle‐Ottawa Scale and Cochrane RoB 2.0 tool. A random‐effects meta‐regression was performed to explore the impact of high‐stage tumors on the outcomes. Results Thirteen studies ( n = 2897) were included. RPLC significantly reduced operative time (MD: −19.98 min; 95% CI: −29.73 to −10.24, p < 0.0001) and estimated blood loss (MD: −13.70 mL; 95% CI: −25.63 to −1.77, p = 0.02) without compromising hospital stay, lymph node yield, or complication rates. Meta‐regression revealed tumor stage significantly influenced operative time ( p = 0.0013). Conclusions RPLC appears to provide comparable postoperative outcomes to MPLC with modest intraoperative advantages. As the evidence is largely retrospective and heterogeneous, these findings indicate the feasibility of RPLC rather than its superiority over MPLC. High‐quality clinical trials with longer follow‐up are required to confirm these findings and optimize clinical decision‐making. Trial Registration PROSPERO registration ID: CRD420251078328