K-CROSS
Trial question
What is the effect of periumbilical transverse incision in patients undergoing laparoscopic colon cancer surgery?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
36.0% female
64.0% male
N = 166
166 patients (60 female, 106 male).
Inclusion criteria: adult patients, aged ≥ 20 years, undergoing laparoscopic colon cancer surgery.
Key exclusion criteria: need for mini-laparotomy of < 1 or ≥ 10 cm; rectal cancer; planned mini-laparotomy outside the umbilical area; planned palliative surgery; planned protective or permanent stoma; emergency surgery; current unhealed wound; fracture; peptic ulcer; abdominal abscess; history of incisional hernia.
Interventions
N=83 transverse incision (a non-muscle-cutting periumbilical transverse incision).
N=83 midline incision (a longitudinal incision made along the midline skin, subcutaneous fat, and linea alba).
Primary outcome
Radiological incisional hernia at 12 months after surgery
6%
18%
18.0 %
13.5 %
9.0 %
4.5 %
0.0 %
Transverse
incision
Midline
incision
Significant
decrease ▼
NNT = 8
Significant decrease in radiological incisional hernia at 12 months after surgery (6% vs. 18%; ARD -12, 95% CI -22.12 to -1.88).
Secondary outcomes
No significant difference in symptomatic incisional hernia at 12 months after surgery (3% vs. 8%; ARD -5, 95% CI -11.96 to 1.96).
No significant difference in median length of hospital stay after surgery (6 days vs. 7 days; MD -1, 95% CI -4.52 to 2.52).
No significant difference in 12-Item Short Form Health Survey-Physical Component Summary at 12 months after surgery (65.3 points vs. 64.8 points; AD 0.5 points, 95% CI -11.4 to 12.4).
Safety outcomes
No significant difference in total complications.
Conclusion
In adult patients, aged ≥ 20 years, undergoing laparoscopic colon cancer surgery, transverse incision was superior to midline incision with respect to radiological incisional hernia at 12 months after surgery.
Reference
Soo Young Lee, Soo Yeun Park, Gi Won Ha et al. Effect of transverse versus midline periumbilical incision on incisional hernia and short-term outcomes after laparoscopic colon cancer surgery: multicentre, open-label, randomized clinical trial. BJS Open. 2025 May 7;9(3):zraf062.
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