Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors

Abstract Background Minimal access surgery is associated with improved cosmetic and other short-term outcomes. Conventionally, an abdominal incision is made for specimen extraction. We assessed the feasibility of specimen extraction through one of the natural orifices and analyzed its impact on short-term outcomes. Methods A prospectively collected data were reviewed on consecutive patients who underwent natural orifice specimen extraction (NOSE) after laparoscopic colorectal surgery. The results were compared with a matched group who had transabdominal extraction (TAE) of the specimens. A systematic literature review was performed to compare our results. Results The combined median operating time for right and left colectomies was significantly higher in the NOSE group as compared with TAE group (260 vs. 150). There was no mortality in either group and no conversions to TAE in the NOSE group. No local metastasis or major iatrogenic injuries were reported at the time of retrieval. The results were comparable to those of a meta-analysis of randomized controlled trials. Conclusion The results of NOSE are comparable to those of TAEs. The absence of a minilaparotomy for specimen extraction may lead to a speedy recovery and better cosmesis.

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Trans-rectal natural orifice specimen extraction (NOSE) during laparoscopic anterior resection: Chinese experience with a novel method

10.21203/rs.2.11291/v1 ◽

2019 ◽

Author(s):

Zhu-Qing Zhou ◽

Kai-Jing Wang ◽

Tao Du ◽

Wei Gao ◽

Zhe Zhu ◽

...

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Sigmoid Colon ◽

Anterior Resection ◽

Sigmoid Colon Cancer ◽

Natural Orifice ◽

Specimen Extraction ◽

Natural Orifice Specimen Extraction ◽

Laparoscopic Anterior Resection ◽

Novel Method

Abstract Background: To introduce a novel method for double stapling technique in colorectal anastomosis during laparoscopic anterior resection of upper rectal or sigmoid colon cancer with trans-rectal natural orifice specimen extraction (NOSE). Methods: From June 2015 and May 2016, patients with upper-rectal or sigmoid colon cancer who received treatment in Shanghai East Hospital were enrolled. Preoperative and postoperative clinical variables were analyzed and compared between groups. Postoperative pain was analyzed utilizing a visual analog scale (VAS). Postoperative overall survival was analyzed using a K-M curve. Results: A total of 99 colorectal cancer cases were randomly divided into NOSE with novel method group (NOSE, n=48) and conventional laparoscopic group (non-NOSE, n=51). No statistically significant differences in preoperative demographics of the patients as sex, age, body mass index were found among the groups. The NOSE group had the longer operation time, but less blood loss than the non-NOSE group. The NOSE group had no abdominal incision and the lower postoperative VAS score. The time for intestinal function recovery and the length of hospital stay (LOS) was statistically significantly different, with the non-NOSE group having the longer time. The incidence of postoperative complications was lower in NOSE group (5/48, 10.4%) than in the non-NOSE group (8/51, 15.7%), the difference was statistically significant. The K-M survival curve showed no statistically significant difference in the disease free survival rate between the NOSE group and non-NOSE group. Conclusion: NOSE with novel method is safe and feasible to use in patients having colorectal cancer. Compared with traditional laparoscopic surgery, the postoperative complication rates of NOSE surgery were lower with an improved short-term clinical recovery.

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