Comparison of NOSES and Conventional Laparoscopic Surgery in Colorectal Cancer: Bacteriological and Oncological Concerns

Abstract

Background: Colorectal natural orifice specimen extraction surgery (NOSES) is considered to be a scarless operation that avoids the laparotomy of extraction specimen, but bacteriological and oncological concerns are raised with this technique. Objective: The purpose of this study was to compare the oncological and bacteriological outcomes of NOSES and conventional laparoscopic (CL) procedures. Methods: This is a retrospective study of prospectively collected outcomes data. Patients operated with colorectal cancer from January 2016 to December 2019 in Xiangya Hospital were assigned to the group NOSES and the group CL according to the size of the tumor. Prior to dissection, peritoneal lavage fluid was collected for cytological assessment. At the end of the procedure, peritoneal lavage fluid was collected for aerobic culture and cytological assessment. Baseline characteristics and short-term and long-term outcomes for NOSES and CL were compared. Results: Between January 2016 and December 2019, 212 patients were enrolled from our center and 185 patients were analyzed (96 and 89 in NOSES and CL groups, respectively). The bacterial positive rate of peritoneal lavage fluid was 34.4 vs. 32.6% in NOSES and CL groups, respectively (P = 0.80). The positive rate of tumor cells in peritoneal lavage fluid was 7.3 vs. 9.0% in NOSES and CL groups, respectively (P = 0.67). Univariate analysis showed that the positive rate of tumor cells in peritoneal lavage fluid was significantly associated with tumor invasion depth and lymph node metastasis (P < 0.05). T4 (OR = 20.47, 95%CI = 1.241-337.661; P = 0.04), N1 (OR = 5.445, 95%CI = 1.412-20.991; P = 0.01), and N2 (OR = 6.315, 95%CI = 1.458-27.348; P = 0.01) served as independent predictors of peritoneal lavage fluid positive oncology patients. Local recurrence-free survival was not significantly different between two groups (HR = 0.909, 95%CI = 0.291-2.840; P = 0.87). Conclusions: Compared with conventional laparoscopic procedure, NOSES is in conformity with the principle of asepsis and tumor-free technique and can be worthy of clinical application and promotion.

Is Natural Orifice Specimen Extraction Surgery Really Safe in Radical Surgery for Colorectal Cancer?

“…The present study confirmed that La-NOSES and CLA were similar to Ouyan’s study ( 19 ) in terms of elevated postoperative inflammatory indicators, with a corresponding increase in postoperative CRP and PCT, and the present study further indicated that both indicators were significantly elevated at POD2 and gradually recovered at POD7. Among them, La-NOSES caused a more significant and statistically significant increase in CRP and PCT.…”

Robotic natural orifice specimen extraction surgery for colorectal cancer: an open-label, single-arm study

“…Therefore, when choosing from these three methods, tumor location should be prioritized over complications [20]. To reduce the risk of infection after NOSES, the international consensus of NOSES recommends that preventive antibiotics should be used before surgery, defecation preparation should be improved, intra-abdominal irrigation should be performed during surgery, a large amount of povidone-iodine and saline should be used for anal cleaning, translucent wound protectors should be used, and pelvic or abdominal drains should be used [3] , [21]. These recommendations were followed in this study to reduce the possibility of bacterial contamination and abdominal infections.…”

Carbon nanoparticle-assisted natural orifice specimen extraction surgery with left colic artery preservation: a retrospective study.

“…As a new star of minimally invasive technology, NOSES is gradually being recognized and accepted by many clinicians because of the potential benefits including reduction in postoperative pain and wound complications, less use of postoperative analgesia, faster recovery of intestinal function, shorter hospital stay, and better cosmetic and psychological effects described in colorectal surgery [16]. Some researchers have proposed that, compared with the conventional laparoscopic procedure, NOSES is in conformity with the principle of asepsis and tumor-free technique and can be worthy of clinical application [17]. A systematic review and meta-analysis of NOSES showed that NOSES is a safe and viable alternative to traditional laparoscopy in colorectal oncology in terms of short-term results [18].…”