<p>Comparison of short-term and survival outcomes for transanal natural orifice specimen extraction with conventional mini-laparotomy after laparoscopic anterior resection for colorectal cancer</p>

Abstract

Background Transanal natural orifice specimen extraction (NOSE) in colorectal surgery has been introduced as a less invasive surgery. However, its long-term survival effects remain controversial. The aim of this study was to compare the short-term and long-term survival outcomes of transanal NOSE with those of the conventional laparoscopic approach with mini-laparotomy (LAP) for anastomosis construction and specimen extraction in sigmoid colon cancer or rectal cancer. Methods From January 2007 to January 2018, a retrospective study was conducted at the China National Cancer Center. In total, 52 consecutive patients who underwent laparoscopic anterior resection with NOSE were matched with an additional 52 patients who underwent conventional LAP for colorectal cancer. Results Patients in the NOSE group experienced shorter time to passage of flatus (2.8±0.8 vs 3.2±0.9 days; p =0.042), less pain (4.2±1.4 vs 5.4±1.7; p =0.003) and less analgesia required (7.7% vs 25.0%; p =0.032). After a median follow-up of 68.5 (range, 8–83) months, the two groups had similar 5-year overall survival rates (92.3% vs 94.2%; p =0.985) and disease-free survival rates (84.6% vs 86.5%; p =0.802). Conclusion Transanal NOSE for total laparoscopic anterior resection is safe and feasible with more advantages, including lower pain, lower tissue trauma and faster recovery of intestinal function. Moreover, with proper protection of the surgical route, transanal NOSE has the same long-term outcomes as conventional laparoscopic surgery.

Short- and long-term outcomes for transvaginal specimen extraction versus minilaparotomy after robotic anterior resection for colorectal cancer: a mono-institution retrospective study

“…Postoperative pain on day 1 after surgery was lower in the TVSE group than the LAP group. Several studies [10,12,20] showed similar results. This reduction may be explained by the fact that minilaparotomy, which traumatizes the abdominal wall, is more likely to cause vessel and nerve injury and lead to increased postoperative somatic pain at the incisional sites [21].…”

“…Previous studies [10,12,19] demonstrated that patients who underwent laparoscopic anterior resection with TVSE for colorectal cancer benefited from shortterm outcomes, such as faster gastrointestinal recovery.…”

Safety and Feasibility of Robotic Natural Orifice Specimen Extraction Surgery in Colorectal Neoplasms During the Initial Learning Curve

“…In addition, numerous reports comparing laparoscopic NOSES with conventional laparoscopic surgery in colorectal surgery exist. Laparoscopic NOSES is safe and feasible with numerous advantages, including reduced pain and tissue trauma, fast recovery of intestinal function, and short postoperative hospital stay duration (19)(20)(21)(22)(23). Two meta-analyses involving 1,435 and 837 patients have also shown that compared with conventional laparoscopic surgery, NOSES may be a safe procedure that can significantly reduce the duration of hospital stay, accelerate postoperative recovery with improved cosmetic results, and in particular, minimize postoperative pain and complications while achieving similar oncological outcomes (24,25).…”

Clinical Application of the Reverse Puncture Technique for Total Laparoscopic Colorectal Resection with Natural Orifice Specimen Extraction

“…Studies have shown [17][18] that adequate intestinal preparation before the operation and standard aseptic and tumour-free conditions during the operation can effectively avoid postoperative abdominal infections. Compared with conventional laparoscopic surgery, the probability of postoperative abdominal infections in patients treated with the NOSE technique does not increase significantly.…”