BackgroundNatural orifice specimen extraction surgery (NOSES) has been confirmed as an alternative approach without auxiliary incisions. The purpose of this study was to investigate the short-term and survival outcomes of NOSES versus conventional laparoscopic surgery (LAP) in treatment of sigmoid and high rectal cancer.MethodThe retrospective study was conducted at single centers between January 2017 to December 2021. Relevant data included clinical demographics, pathological features, operative parameters, postoperative complications and survival outcomes were collected and analyzed. All procedures were performed using either a NOSES or a conventional LAP approach. Propensity score matching (PSM) was conducted to balance clinical and pathological features between the two groups.ResultsAfter PSM, a total of 288 patients were eventually included in this study, 144 in each group. Patients in the NOSES group experienced faster recovery of gastrointestinal function (2.6 ± 0.8 vs. 3.6 ± 0.9 day, P = 0.037), less pain and less analgesia required (12.5% vs. 33.3%, P < 0.001). In addition, the incidence of surgical site infection in the LAP group was significantly higher than that in the NOSES group (12.5% vs. 4.2%, P = 0.011), especially incision-related complications (8.3% vs. 2.1%, P = 0.017). After a median follow-up of 32 (range, 3–75) months, the two groups had similar 3-year overall survival rates (88.4% vs. 88.6%; P = 0.850) and disease-free survival rates (82.9% vs. 77.2%; P = 0.494).ConclusionThe transrectal NOSES procedure is a well-established strategy with advantages in reducing postoperative pain, faster recovery of gastrointestinal function, and less incision-related complications. In addition, the long-term survival is similar between NOSES and conventional laparoscopic surgery.
Objective The purpose of this study was to assess the safety and feasibility of radical surgery and to investigate prognostic factors influencing in colorectal cancer (CRC) patients over the age of 80. Methods Between January 2010 and December 2020, 372 elderly CRC patients who underwent curative resection at the National Cancer Center were enrolled in the study. Preoperative clinical characteristics, perioperative outcomes, and postoperative pathological features were all collected. Results A total of 372 elderly patients with colorectal cancer were included in the study, including 226 (60.8%) men and 146 (39.2%) women. A total of 219 (58.9%) patients had a BMI < 24 kg/m2, and 153 (41.1%) patients had a BMI ≥ 24 kg/m2. The mean operation time and intraoperative blood loss were 152.3 ± 58.1 min and 67.6 ± 35.4 ml, respectively. The incidence of overall postoperative complications was 28.2% (105/372), and the incidence of grade 3–4 complications was 14.7% (55/372). In the multivariable Cox regression analysis, BMI ≥ 24 kg/m2 (HR, 2.30, 95% CI, 1.27–4.17; P = 0.006) and N1-N2 stage (HR: 2.97; 95% CI, 1.48–5.97; P = 0.002) correlated with worse CSS. Conclusion The findings of this study showed that radical resection for CRC is safe and feasible for patients over the age of 80. After radical resection, BMI and N stage were independent prognostic factors for elderly CRC patients.
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