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

Abstract

BackgroundThe main feature of natural orifice specimen extraction (NOSE) is its avoidance of an auxiliary abdominal incision. The safety of NOSE remains controversial. This study aimed to investigate the early safety of transanal NOSE in the treatment of sigmoid colon and upper rectal cancer from the follow aspects: clinical and pathological characteristics, inflammatory and immune indicators and postoperative complications.MethodsData from 125 patients diagnosed with sigmoid colon, and upper rectal cancer by gastrointestinal surgery in the First Affiliated Hospital of Wannan Medical College from January 2017 to June 2020 were analyzed. Patients were assigned to two surgical groups: Conventional laparoscopic-assisted radical resection for CRC (CLA, 75cases) and laparoscopic-assisted radical resection for CRC with NOSE (La-NOSE, 50 cases). The following were compared: clinical and pathological characteristics; intraoperative, bacteriological, and oncological results; postoperative inflammation and immune response indexes. Bacteriological results were obtained by aerobic and anaerobic bacterial culture of peritoneal wash fluid and oncology results by cytological analysis of peritoneal wash liquid exudation. Inflammation indicators included postoperative C-reactive protein (CRP) and procalcitonin (PCT) trend reactions. The immune index was the level of postoperative T lymphocytes (CD3, CD4/CD8). All data were analyzed by using SPSS statistical version 18.0 for windows. Measurement data are presented as the means ± standard deviations, and two-group comparisons were performed using the t-test. Comparisons of count data were performed using the chi-square test. p <0.05 indicates that the difference was statistically significant.ResultsThe bacterial culture positive rate was not significant in the La-NOSE group (15/50 vs 19/75) than in the CLA group. The exfoliative cytology (EC) rate of the peritoneal wash fluid was 0 in both groups.The La-NOSE group had a significantly higher postoperative day 2(POD2) CRP and PCT level than the CLA group. The POD2 CD3 and CD4/CD8 levels were higher in the La-NOSE group than in the CLA group. There was no significant difference in the incidence of postoperative complications between the two groups (La-NOSE group vs CLA group: 3/50 vs 6/75) (p>0.05).ConclusionsAlthough the incidence of intra-abdominal contamination is high, it does not develop into a severe infectious disease, and does not lead to the implantation of free tumor cells into the abdominal cavity. Therefore, it is safe for the NOSE to treat colorectal cancer.

Reduced-port laparoscopic colectomy with D3-lymph node dissection and transvaginal specimen extraction (NOSES VIIIa) for right colon cancer: clinical features

“…However, extensive multicenter studies [20][21][22] have shown that preoperative ushing of the bowel with povidone-iodine solution and postoperative abdominal lavage signi cantly reduce the risk of infection. The fact that no complications were observed in the RPLS + NOSE group in our study demonstrates that strict adherence to aseptic technique and pro ciency in retrieving specimens through the natural lumen can be effective in reducing such risks.…”

Laparoscopic-Assisted Colorectal Resection Can Reduce the Inhibition of Immune Function Compared with Conventional Open Surgery: A Retrospective Clinical Study

“…T cells can be divided into two subpopulations, CD3 + CD4 + and CD3 + CD8 + T cells, according to different surface antigens, and the balance between them is an important insurance for maintaining normal immune system work, and the ratio of the two is an important indicator to assess immune function [ 6 , 7 ]. In a recent study, CD3 + T lymphocytes and CD4 + /CD8 + ratio levels on the second postoperative day were determined to be higher in patients who underwent laparoscopic-assisted natural orifice specimen extraction than in the conventional laparoscopic-assisted radical resection group, thus confirming the early safety after laparoscopic-assisted natural orifice specimen extraction [ 8 ]; Gang Wang et al showed that fast-track surgery had better protection of patients’ immune function postoperatively compared to laparoscopic surgery, with less impact on CD3 + ,CD4 + T lymphocytes, CD4 + /CD8 + ratio and fewer perioperative complications [ 9 ]. Hence, detecting changes in T-lymphocyte subsets in peripheral blood and using them to assess immune response have aroused the people’s interests.…”

Feasibility and safety of specimen extraction via an enlarged (U-Plus) skin bridge loop ileostomy: a single-center retrospective comparative study

“…Currently, the most prevalent approach involves making an auxiliary incision in the abdomen to facilitate the specimen's extraction. Additionally, there is literature supporting the use of Natural Orifice Specimen Extraction Surgery (NOSES) or specimen extraction via the ileostomy site to enhance the surgical outcome (10)(11)(12). In some cases, performing NOSES in patients with larger tumors or thickened intestinal walls and mesentery can be challenging or unsuccessful.…”