Yu Ding1, Zenan Li, Haiting Gao, Yu Cao, Weisen Jin. 1. Institute of Anorectalology, the Third Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China.
Abstract
PURPOSE: To compare the short-term efficacy between natural orifice specimen extraction (NOSE) without abdominal incision and conventional laparoscopic surgery in the treatment of sigmoid colon cancer and upper rectal cancer. METHODS: A total of 86 patients scheduled to undergo laparoscope-assisted radical surgery of sigmoid cancer or upper rectal cancer from January 2015 to September 2017 (T1-3 stages in preoperative imaging evaluation, no distant metastasis, and body mass index <28 kg/m2) were selected and randomly divided into the NOSE group (no abdominal incision, n=43) and conventional laparoscopy group (LA group, n=43). The operation time, amount of intraoperative bleeding, postoperative exhaust time, postoperative diet time, postoperative hospitalization duration, postoperative pain score and perioperative complications were compared between the two groups. The pathological conditions of surgical specimens were recorded. The postoperative recurrence rate of tumor and survival rate of patients were also recorded and compared. RESULTS: The general clinical features were comparable between the two groups, and there were no perioperative deaths. The operation time in NOSE group was slightly longer than that in LA group, without statistically significant difference (p=0.130). In NOSE group, the amount of intraoperative bleeding was significantly smaller than in LA group [(59.31±14.64) mL vs. (75.41±18.16) mL, p<0.001], the postoperative visual analogue scale (VAS) score was significantly lower than that in LA group [(4.2±1.6) points vs. (5.9±1.4) points, p<0.001], and the postoperative exhaust time and regular diet time were significantly shorter than those in LA group [(2.1±1.0) d vs. (2.6±1.2) d, p=0.039, (3.8±1.1) d vs. (4.4±1.4) d, p=0.030]. The cosmetic result in NOSE group was better than that in LA group [(8.0±1.5) vs. (6.4±1.1), p<0.001]. Moreover, the comparison results of surgical specimens showed that there were no statistically significant differences in the intestine resection length, proximal and distal resection margins, tumor size, number of lymph nodes dissected and TNM stage of tumor between the two groups (p>0.05). The postoperative tumor recurrence rate had no significant difference between the two groups (p=0.359), and the Log-rank test revealed that the disease-free survival (DFS) rate had no statistically significant difference between the two groups (p=0.280). CONCLUSIONS: NOSE without abdominal incision has a comparable short-term clinical efficacy to conventional laparoscopic surgery in the treatment of sigmoid cancer and upper rectal cancer, but it significantly reduces the amount of intraoperative bleeding and lowers the pain of patients, with rapid postoperative recovery and high safety, so it is worthy of clinical popularization.
RCT Entities:
PURPOSE: To compare the short-term efficacy between natural orifice specimen extraction (NOSE) without abdominal incision and conventional laparoscopic surgery in the treatment of sigmoid colon cancer and upper rectal cancer. METHODS: A total of 86 patients scheduled to undergo laparoscope-assisted radical surgery of sigmoid cancer or upper rectal cancer from January 2015 to September 2017 (T1-3 stages in preoperative imaging evaluation, no distant metastasis, and body mass index <28 kg/m2) were selected and randomly divided into the NOSE group (no abdominal incision, n=43) and conventional laparoscopy group (LA group, n=43). The operation time, amount of intraoperative bleeding, postoperative exhaust time, postoperative diet time, postoperative hospitalization duration, postoperative pain score and perioperative complications were compared between the two groups. The pathological conditions of surgical specimens were recorded. The postoperative recurrence rate of tumor and survival rate of patients were also recorded and compared. RESULTS: The general clinical features were comparable between the two groups, and there were no perioperative deaths. The operation time in NOSE group was slightly longer than that in LA group, without statistically significant difference (p=0.130). In NOSE group, the amount of intraoperative bleeding was significantly smaller than in LA group [(59.31±14.64) mL vs. (75.41±18.16) mL, p<0.001], the postoperative visual analogue scale (VAS) score was significantly lower than that in LA group [(4.2±1.6) points vs. (5.9±1.4) points, p<0.001], and the postoperative exhaust time and regular diet time were significantly shorter than those in LA group [(2.1±1.0) d vs. (2.6±1.2) d, p=0.039, (3.8±1.1) d vs. (4.4±1.4) d, p=0.030]. The cosmetic result in NOSE group was better than that in LA group [(8.0±1.5) vs. (6.4±1.1), p<0.001]. Moreover, the comparison results of surgical specimens showed that there were no statistically significant differences in the intestine resection length, proximal and distal resection margins, tumor size, number of lymph nodes dissected and TNM stage of tumor between the two groups (p>0.05). The postoperative tumor recurrence rate had no significant difference between the two groups (p=0.359), and the Log-rank test revealed that the disease-free survival (DFS) rate had no statistically significant difference between the two groups (p=0.280). CONCLUSIONS: NOSE without abdominal incision has a comparable short-term clinical efficacy to conventional laparoscopic surgery in the treatment of sigmoid cancer and upper rectal cancer, but it significantly reduces the amount of intraoperative bleeding and lowers the pain of patients, with rapid postoperative recovery and high safety, so it is worthy of clinical popularization.