Correspondence on international consensus on natural-orifice specimen-extraction surgery (NOSES) for colorectal cancer

Nunoo‐Mensah, Joseph W.; Rizk, Mariam

doi:10.1093/gastro/goaa055

Cited by 13 publications

(28 citation statements)

References 10 publications

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“…However, as this new procedure continues to be performed, new questions are being raised: is NOSE for colorectal cancer truly consistent with the principle of tumor-free asepsis and does the NOSE technique have an impact on the long-term prognosis of patients? [ 8 , 14 ] The current research evidence on this aspect is not yet sufficient. In this study, we investigated complete laparoscopic radical resection of colorectal cancer without incision anastomosis using available case resources.…”

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 98%

“…In recent years, there have been reports showing no significant difference in the recent outcomes of NOSE for colorectal cancer compared with conventional laparoscopic surgery [ 7 ]. However, with the continuous development of NOSE, some concerns have been raised regarding the surgical safety of this method of specimen retrieval, especially regarding the principle of tumor-free asepsis [ 8 ]. Although some NOSE centers, including our research team, have confirmed the feasibility of this procedure through retrospective studies with small samples, and other research teams have recently affirmed the safety in terms of tumor-free asepsis, the research evidence is insufficient and lacks high-level evidence [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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

Zheng¹,

Cao²,

Zheng³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction: Complete laparoscopic radical resection of colorectal cancer without incision anastomosis is performed by means of natural orifice specimen extraction (NOSE), which avoids a large abdominal wall incision. Although this procedure is increasingly practiced, it is still underdeveloped, one reason being that controversy still exists regarding bacteriological and oncological safety. Aim: To demonstrate the safety of complete laparoscopic radical resection of colorectal cancer without incision anastomosis in bacteriology and oncology.Material and methods: This study was a retrospective study with prospectively collected data. This study continuously collected 420 patients who underwent colorectal cancer surgery in our hospital from January 2018 to March 2022. According to the different surgical methods, they were divided into the NOSE group (the natural orifice specimen extraction group) and the N-NOSE group (specimen removed through abdominal wall auxiliary incision). The two groups were matched 1 : 1 using the propensity score matching (PSM) method to balance at baseline. Bacteriological and oncological outcomes, short-term complications, and long-term prognosis were compared between the two groups.Results: One hundred and eighty-four of the 420 included patients were successfully matched. The differences in gender, body mass index, T stage, N stage, and diabetes status between the two groups after matching were not statistically significant. There were no significant differences in oncological outcomes, short-term complications, and 2-year postoperative disease-free survival between the two groups. There was no significant correlation between positive bacterial culture results and intra-abdominal infection. Conclusions: Compared with traditional laparoscopic surgery, complete laparoscopic radical resection of colorectal cancer without incision anastomosis has satisfactory bacteriological and oncological effects and is worthy of further clinical promotion.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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

Zheng¹,

Cao²,

Zheng³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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show abstract

“…Certainly, larger RCT studies are needed in both colon cancer and gastric cancer. At present, the international consensus on NOSES for gastric cancer indicates that the use of a sterile plastic sleeve and pelvic irrigation could effectively prevent tumor dissemination [ 29 ]. McKenzie et al reported in colon cancer that the risk of tumor seeding after transvaginal delivery was no higher than the risk associated with transabdominal extraction utilizing a specimen retrieval bag [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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

Meng¹,

Yang²,

Bao³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction: Natural orifice specimen extraction (NOSE) laparoscopic surgery is emerging as a new and promising technique, especially in gastric cancer (GC). Aim: To analyze the difference between transvaginal and transumbilical specimen extraction following totally laparoscopic gastrectomy (TLG)Material and methods: Between January 2016 and July 2021, 37 consecutive female patients with GC who underwent either natural orifice specimen extraction surgery (NOSES) or TLG at our center were included and analyzed. Results: In total, 12 patients underwent NOSES, and 25 patients underwent TLG. The NOSES group had a shorter operative time (239.3 ±21.5 vs. 256.1 ±21.2 min, p = 0.031) and shorter specimen extraction time (17.0 ±4.2 vs. 30.8 ±4.3 min, p < 0.01). No significant difference was observed in the comparison of the radical validity including estimated blood loss, the number of harvested LNs and the comparisons of distal and proximal margin. In the postoperative recovery comparisons, the NOSES group had a shorter time to first fluids (3.9 ±0.5 vs. 5.6 ±1.2 days, p < 0.01), and time to starting a soft diet (5.6 ±0.7 vs. 7.7 ±1.7 days, p < 0.01). Postoperative pain in the NOSES group was significantly less. Postoperative hospital stay days in the NOSES group were fewer (10.2 ±2.2 vs. 12.4 ±2.9 days, p = 0.030). Overall, the postoperative complications were similar between the two groups (p = 0.438). When more cases were included, the results were similar. NOSES reduced hospital costs for GC patients, and it also applied to the premenopausal patients. Conclusions: NOSES was a safer and more reliable method as compared to transumbilical specimen extraction.

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“…atural orifice specimen extraction (NOSE) is a viable alternative to conventional transabdominal specimen retrieval in colorectal surgery that reduces pain and wound complications and results in an improved postoperative recovery process. [1][2][3] Transvaginal NOSE has been described following hepatectomies. 4,5 To our knowledge, transanal specimen extraction following laparoscopic liver-only resection has not yet been reported.…”

mentioning

confidence: 99%

Transanal Natural Orifice Specimen Extraction Following Combined Laparoscopic Anterior Resection and Liver Resection

Seow‐En

Koh

Tan

2023

Diseases of the Colon &Amp; Rectum

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Correspondence on international consensus on natural-orifice specimen-extraction surgery (NOSES) for colorectal cancer

Cited by 13 publications

References 10 publications

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

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

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

Transanal Natural Orifice Specimen Extraction Following Combined Laparoscopic Anterior Resection and Liver Resection

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