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

Abstract

Background: Colorectal cancer resection surgery with transvaginal specimen extraction is becoming increasingly accepted and used by surgeons. However, few publications on robotic anterior sigmoid colon and rectal cancer resection with transvaginal specimen extraction (TVSE) have been reported, and a clinical outcome comparison between conventional robotic minilaparotomy (LAP) and transvaginal specimen extraction in anterior sigmoid colon and rectal cancer resection has not been performed. The current study compared the short-and long-term outcomes of TVSE and LAP for sigmoid colon cancer and rectal cancer in a mono-institution. Methods: From December 2014 to October 2018, 45 patients who underwent TVSE and 45 patients who underwent LAP matched by tumor location, tumor stage, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, gender, and age at the same period were included in the current study. The short-and long-term outcomes of TVSE and LAP were discussed. Results: No significant differences were found in patient characteristics. For the short-term outcomes, the operative time in the TVSE group was longer than that in the LAP group, and the postoperative pain and additional analgesia were lower in the TVSE group. Patients in the TVSE group required slightly less time to pass first flatus. There were no significant differences in overall complications, time to regular diet, length of hospital stay after surgery, estimated blood loss, or pathological outcomes. For long-term outcomes, the 3-year overall survival (94.9% vs. 91.7%, p = 0.702) and 3-year disease-free survival (88.4% vs. 86.2%, p = 0.758) were comparable between the two groups. Conclusion: The robotic TVSE is safe and feasible in selected sigmoid/upper rectal cancer patients with tumor diameter < 5 cm. This approach has slightly better short-term outcomes in terms of less postoperative pain and less analgesic requirements without any significant difference in long-term outcomes.

Transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic partial or radical nephrectomy: a preliminary study

“…But some scholars believe that transvaginal NOSES may cause problems with tumor implantation or wound infection, one meta-analysis concluded that there was no significant difference in oncological outcomes between the NOSES group and the traditional abdominal incision group [9]. Similar results were obtained by Gao et al [10] who showed no significant difference in 3-year overall survival and disease-free survival between the two groups. In our study, patients did not experience tumor recurrence, implant metastasis within the follow-up date, and also did not experience infection problems in their perioperative wounds, which were more desirable than those of conventional surgery.…”

Cosmesis and feasibility of transvaginal natural orifice Specimen extraction (NOSE) for large organ specimen: a prospective pilot study

“…A systematic review concluded that there was no significant difference in oncologic outcomes between NOSE and abdominal incision groups [ 9 ]. One study reported similar overall survival and disease-free survival between the two approaches, and another study reported no tumor implantation problems during the follow-up period after the NOSE procedure [ 10 , 11 ]. The use of a protective bag before specimen extraction would reduce the risk of cancer cell implantation.…”

Robotic natural orifice specimen extraction surgery I-type F method vs conventional robotic resection for lower rectal cancer

“…Previous studies[ 5 , 7 , 8 , 17 ] have confirmed the safety and feasibility of robotic NOSES surgery as a minimally invasive procedure, enhancing surgical quality and expediting postoperative recovery. Robotic resection using the NOSES I-type F method (R-NOSES I-F) represents a novel approach characterized by intussusception to achieve transanal specimen eversion.…”