Short- and long-term outcomes as well as anal function of transanal natural orifice specimen extraction surgery versus conventional laparoscopic surgery for sigmoid colon or rectal cancer resection: a retrospective study with over 5-year follow-up.

Abstract

Introduction:To date, long-term safety including functional outcomes of transanal natural orifice specimen extraction surgery (NOSES) for colorectal cancer resection has not been confirmed. Aim: To explore the short-and long-term outcomes as well as anal function of transanal NOSES versus conventional laparoscopic surgery for sigmoid colon or rectal cancer resection. Material and methods: A retrospective review of data from a prospectively maintained database was performed to analyze the data of 69 patients who underwent transanal NOSES for sigmoid colon or rectal cancer resections and another 69 matched patients who underwent conventional laparoscopic (CL) surgery. Anal function of patients was evaluated using the Wexner fecal incontinence scale postoperatively. Results: Transanal NOSES resulted in faster recovery of intestinal function, shorter postoperative length of stay, less incisional pain, fewer postoperative complications and shorter scars than CL surgery (p < 0.05). The two groups had similar overall survival (p = 0.863) and disease-free survival (p = 0.961). Wexner scores of the NOSES group at 1, 3 and 6 months after surgery were higher than in the CL group (p < 0.05), and there was no difference between the two groups at 12, 18 and 24 months after surgery. Conclusions: Transanal NOSES achieves similar survival outcomes to CL surgery. Transanal NOSES has the advantages of faster recovery, shorter postoperative hospital stay, less incisional pain, shorter scars, etc. However, transanal NOSES can indeed impair anal function, needing more attention.

Bacteriological and oncological safety of complete laparoscopic radical resection of colorectal cancer without incision anastomosis based on propensity-matched scores.

“…It can be assumed that even though the tumor cell test result is positive, it does not affect the long-term outcome of patients in the NOSE group, and the 2-year disease-free survival rate after surgery is at least comparable to that of conventional surgery. This is in line with the findings of existing studies [ 9 , 13 , 20 ]. In 2019, Liu et al also demonstrated through a meta-analysis that NOSE for colorectal cancer can achieve satisfactory oncological outcomes [ 21 ].…”

Short-term outcomes of transvaginal specimen extraction versus transumbilical specimen extraction following totally laparoscopic gastrectomy in female patients with gastric cancer: a retrospective analysis.

“…Faster postoperative recovery also reduced the cost of surgery and significantly reduced the economic burden for gastric cancer patients. This result of rapid recovery is also seen in NOSES group patients with sigmoid colon cancer or rectal cancer resection [13]. Meanwhile, similar results from faster postoperative recovery were observed when we included case reports.…”

“…Natural orifice specimen extraction was a surgical method that aimed to reduce surgical trauma by removing the need for an incision into the abdominal wall [ 24 ]. The incision to extract the specimen was usually made in the rectum [ 13 ], vagina or mouth. Although the NOSES-related reports were limited in gastrectomy, the use of NOSES in both EGC and AGC had been confirmed to be feasible and safe [ 8 , 18 ].…”

“…Limited to the short-term outcomes of this study, we did not analyze the long-term follow-up of the 2 patients, and the related long-term follow-up results have rarely been reported in other reports on GC. However, in colorectal cancer, long-term follow-up of the NOSES patients showed no implantation metastasis compared to the traditional umbilical specimen extraction, and there was no significant difference in survival between the two groups [ 13 ]. Certainly, larger RCT studies are needed in both colon cancer and gastric cancer.…”

“…This procedure allowed for specimen extraction through natural orifices including the anus, vagina, or mouth without additional abdominal incisions [10]. Currently, NOSES is widely used in colon cancer [11][12][13]. In June 2014, the first NOSE following gastrectomy was performed [14].…”