A nomogram for predicting feasibility of laparoscopic anterior resection with trans-rectal specimen extraction (NOSES) in patients with upper rectal cancer

Abstract Background Laparoscopic anterior resection with trans-rectal specimen extraction (NOSES) has been demonstrated as a safe and effective technique in appropriate patients with upper rectal cancer (RC). However, improper selection of RC candidates for NOSES may lead to potential surgical and oncological unsafety as well as complications such as bacteria contamination and anastomotic leak. Unfortunately, no tools are available for evaluating the risk and excluding improper cases before surgery. This study aims to estimate its clinical relevancy and to investigate independent clinical-pathological predictors for identifying candidates for NOSES in patients with upper RC and to develop a validated scoring nomogram to facilitate clinical decision making. Methods The study was performed at Shanghai East hospital, a tertiary medical center and teaching hospital. 111 eligible patients with upper RC who underwent elective laparoscopic anterior resection between February and October of 2017 were included in the final analysis. Univariate and multivariate analyses were performed to compare characteristics between the two surgical techniques. Odds ratios (OR) were determined by logistic regression analyses to identify and quantify the clinical relevancy and ability of predictors for identifying NOSES candidate. The nomogram was constructed and characterized by c-index, calibration, bootstrapping validation, ROC curve analysis, and decision curve analysis. Results Upper RC patients with successful NOSES tended to be featured with female gender, negative preoperative CEA/CA19-9, decreased mesorectum length (MRL), ratio of diameter (ROD) and ratio of area (ROA) values, while no significant statistical correlations were observed with age, body mass index (BMI), tumor location, and tumor-related biological characteristics (ie., vascular invasion, lymph node count, TNM stages). Furthermore, the two techniques exhibited comparably low incidence of perioperative complications and achieved similar functional results under the standard procedures. The nomogram incorporating three independent preoperative predictors including gender, CEA status and ROD showed a high c-index of 0.814 and considerable reliability, accuracy and clinical net benefit. Conclusions NOSES for patients with upper RC is multifactorial; while it is a safe and efficient technique if used properly. The nomogram is useful for patient evaluation in the future.

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A nomogram for predicting feasibility of laparoscopic anterior resection with trans-rectal specimen extraction (NOSES) in patients with upper rectal cancer

10.21203/rs.3.rs-256283/v1 ◽

2021 ◽

Author(s):

Zhen-yu Zhang ◽

Zhe Zhu ◽

Yuanyuan Zhang ◽

Li Ni ◽

Bing Lu

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Clinical Decision Making ◽

Surgical Techniques ◽

Curve Analysis ◽

Specimen Extraction ◽

Laparoscopic Anterior Resection ◽

Lymph Node Count ◽

Proper Patient Selection ◽

Selection Of

Abstract BackgroundLaparoscopic anterior resection with trans-rectal specimen extraction (NOSES) has been demonstrated as a safe and effective technique in selected patients with upper rectal cancer (RC). However, improper selection of RC candidates for NOSES may lead to complications such as bacteria contamination and anastomotic leak. Unfortunately, no tools are available for evaluating the risk and excluding improper cases before surgery. This study aims to investigate independent clinical-pathological predictors for selection of candidates for NOSES surgery in upper RC and to develop a validated scoring nomogram to facilitate clinical decision making.MethodsThe study was performed at Shanghai East hospital, a tertiary medical center and teaching hospital. A consecutive and eligible serial of 111 patients with upper RC underwent elective laparoscopic anterior resection with or without NOSES between February and October of 2017. Multivariate analyses were performed to compare characteristics between the two surgical techniques. Odds ratios (OR) were determined by logistic regression analyses to identify and quantify the ability of predictors for selection of NOSES. The nomogram was constructed and characterized by c-index, calibration, bootstrapping validation, ROC curve analysis, and decision curve analysis.ResultsUpper RC patients with successful NOSES tended to be featured with female gender, negative preoperative CEA/CA19-9, decreased mesorectum length (MRL)，ratio of diameter (ROD) and ratio of area (ROA) values, while no significant correlations were observed with age, body mass index (BMI), tumor location, and tumor-related biological characteristics (ie., vascular invasion, lymph node count, TNM stages). The nomogram incorporating three independent preoperative predictors including gender, CEA status and ROD achieved a high c-index of 0.814 and considerable reliability, accuracy and clinical net benefit.ConclusionsNOSES for patients with upper RC is multifactorial. The first nomogram is useful for proper patient selection in the future.

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Transanal natural orifice specimen extraction for laparoscopic anterior resection in rectal cancer

World Journal of Gastroenterology ◽

10.3748/wjg.v19.i43.7751 ◽

2013 ◽

Vol 19 (43) ◽

pp. 7751 ◽

Cited By ~ 14

Author(s):

Fang-Hai Han

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Natural Orifice ◽

Specimen Extraction ◽

Natural Orifice Specimen Extraction ◽

Laparoscopic Anterior Resection

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PREVENTION OF COLORECTAL ANASTOMOTIC LEAK

Kharkiv Surgical School ◽

10.37699/2308-7005.5-6.2019.04 ◽

2019 ◽

pp. 21-25

Author(s):

Andrii Klymenko ◽

Igor Kononenko

Keyword(s):

Rectal Cancer ◽

Anastomotic Leak ◽

Anterior Resection ◽

Colorectal Anastomosis ◽

Surgical Techniques ◽

Control Group ◽

Laparoscopic Anterior Resection ◽

Anastomotic Technique ◽

Perioperative Morbidity ◽

Protective Ileostomy

Summary. Colorectal anastomotic leak after low anterior resection of sigmoid colon and rectum is one of the hardest complications leading to perioperative morbidity and mortality increase and prolonged hospital stay. One of the directions of contemporary research includes assessment and improval of anastomotic technique as well with the use of staplers to decrease the risk of anastomotic leak and rate of uncomfortable protective ileostomy. There is no consensus today about this matter. In our research we dealt with the results of 92 patients after laparoscopic anterior resection for rectal cancer. The main group consisted of 32 (32.9%) patients who had undergone laparoscopic anterior resection for rectal cancer with the use of modified in our clinic anastomotic technique and intraoperative videoscopic assessment of the colorectal anastomosis. The control group consisted of 60 (65.2%) patients after standard traditional laparotomy for rectal cancer. 7.6% of the patients in total had specific related to the surgical techniques complications at the intra and postoperative period with no statistic difference between the groups. The modified in the clinic anastomotic technique which includes oversawing of the stapler line with seroserous stitches and anastomose assessment by simple laparoscope videorectoscopy proved to be useful and prevented leak in all the patients.

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Integration of transanal specimen extraction into laparoscopic anterior resection with total mesorectal excision for rectal cancer: a consecutive series of 179 patients

Surgical Endoscopy ◽

10.1007/s00464-012-2440-z ◽

2012 ◽

Vol 27 (1) ◽

pp. 127-132 ◽

Cited By ~ 29

Author(s):

Morris E. Franklin ◽

Song Liang ◽

Karla Russek

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Anterior Resection ◽

Consecutive Series ◽

Mesorectal Excision ◽

Specimen Extraction ◽

Laparoscopic Anterior Resection ◽

Transanal Specimen Extraction

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A Novel Method of Natural Orifice Specimen Extraction Surgery (NOSES) during Laparoscopic Anterior Resection for Rectal Cancer

Gastroenterology Research and Practice ◽

10.1155/2021/6610737 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Jun Wang ◽

Jun Hong ◽

Qianwei Wang ◽

Fen Luo ◽

Fenghua Guo

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Clinicopathological Characteristics ◽

Postoperative Outcomes ◽

Conventional Group ◽

Reconstruction Method ◽

Natural Orifice ◽

Specimen Extraction ◽

Natural Orifice Specimen Extraction ◽

Laparoscopic Anterior Resection

We propose a modification to the reconstruction method of natural orifice specimen extraction surgery (NOSES) during laparoscopic anterior resection (LAR) for rectal cancer (RC) and evaluated its feasibility and short-term safety by comparing surgical and postoperative outcomes with those of conventional LAR. Twenty patients with RC underwent “double-purse” NOSES-LAR from October 2017 to June 2018. Data of clinicopathological characteristics, surgical and postoperative outcomes, and follow-up findings in NOSES-LAR cases were collected and retrospectively compared with those of conventional LAR to clarify the clinical benefits. The median postoperative hospital stay was lower in the double-purse NOSES group than the conventional group (6.6 vs. 7.1 days, respectively). In the conventional group, anastomotic leakage and incision site infection occurred in one patient each. In contrast, there were no complications in the double-purse group. There were no significant differences in blood loss, surgical duration, and time of the first flatus between the two groups. Additionally, “double-purse” NOSES-LAR was more economical than the conventional LAR. “Double-purse” NOSES-LAR is a safe, feasible, and minimally invasive promising procedure for LAR of RC with faster recovery, while requiring less surgical skills and lower clinical costs.

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