Natural Orifice Specimen Extraction Surgery versus Conventional Laparoscopic-Assisted Resection in the Treatment of Colorectal Cancer: A Propensity-Score Matching Study

Abstract

Background Natural orifice specimen extraction surgery (NOSES) has been successfully applied to the treatment of gastric, colorectal cancer (CRC). However, the development of NOSES is still in the exploratory stage, and there is still no strong evidence-based medical evidence. Patients and Methods From January 2013 to June 2017, consecutive patients with colorectal cancer who underwent transluminal resection, anastomosis, and specimen extraction and those who underwent conventional laparoscopic resection were enrolled. Propensity score matching was used to align clinicopathological features between the two groups. Results A total of 372 patients were eventually included in this study, 186 in each group. According to perioperative information and postoperative follow-up in both groups, the NOSES group had less blood loss (P = 0.011), shorter time to recovery of gastrointestinal function (P < 0.001), shorter postoperative hospital stay (P = 0.037). The NOSES group had fewer postoperative analgesics (P < 0.001), lower postoperative pain scores (P < 0.001), and lower incidence of postoperative complications (P = 0.017). Compared with the LA (laparoscopic) group, the NOSES group had better physical function (P<0.05), role function (P<0.001), emotional function (P<0.001) and global health status than LA group, while symptoms such as pain (P<0.001), insomnia (P<0.001), constipation (P<0.001) and diarrhea (P<0.05) were less severe in the NOSES group. In addition, the NOSES group had higher body image scores. Overall survival (OS) and disease-free survival (DFS) were not significantly different between the two groups. Conclusion For surgical treatment of colorectal cancer, NOSES has advantages in reducing postoperative pain, recovery of gastrointestinal function, postoperative quality of life, and improving patients’ satisfaction with abdominal wall aesthetics. There was no difference in long-term survival between NOSES and conventional laparoscopic surgery.

Role of Phenotypes of Circulating Tumor Cells in the Diagnosis and Treatment of Colorectal Cancer

“…Both procedures are performed laparoscopically, except that the specimen is obtained in a different manner, and the two procedures are considered to have the same therapeutic effect. 29,30 We first verified that not only the number of CTCs will decrease, but also the proportion of M-CTCs will decrease significantly after surgery, which proves that surgery can reduce the proportion of M-CTCs.…”

Long-term oncologic outcomes of natural orifice specimen extraction surgery versus conventional laparoscopic-assisted resection in the treatment of rectal cancer: a propensity-score matching study

“…Laparoscopic radical resection for rectal cancer has been widely used, but the assisted incision in the abdominal wall could induce great trauma to the patients, which was not conducive to the postoperative recovery of the patient [ 18 , 19 ]. In recent years, with the development of minimally invasive technique, NOSES has become one of the most popular producers, which has the advantages of less trauma, shorter scar, shorter healing time, and fewer complications [ 20 , 21 ]. The results of this study showed that intraoperative blood loss, additional analgesic use, postoperative gastrointestinal recovery time, and hospital stay in the NOSES group were better than those in the conventional laparoscopic group.…”

Development and future perspectives of natural orifice specimen extraction surgery for gastric cancer

“…There are now increasing numbers of related reports and patients undergoing this operation. Tang et al [ 16 ] found that the NOSES group had advantages in terms of reducing postoperative complications and postoperative pain, faster recovery of gastrointestinal function, and shorter postoperative hospital stay. Most notably, the physical function, role function, emotional function, and overall health status in the NOSES group were significantly better than those in the conventional laparoscopic surgery group.…”

“…One patient developed a surgical site infection and one patient had fluid collection at the suture site which prolonged hospital stay to 8 d. Following a comparative analysis, the researchers believe that the NOSES technique is a promising, safe, and effective minimally invasive surgery. Recently, Tang et al [ 16 ] used a type of NOSES to perform Roux-en-Y reconstruction after laparoscopic total gastrectomy with two circular staplers (one of which was oval). The advantage of this technique is that it can be applied to the tumor located very close to the cardia.…”