Minimally Invasive Surgery Program, Legacy Health, Portland OR, USA.
Surg Oncol. 2011 Sep;20(3):211-8. doi: 10.1016/j.suronc.2010.07.005. Epub 2010 Sep 15.
Natural orifice transluminal endoscopic surgery (NOTES) is a new concept that attempts to reduce the impact of surgery on the patient. In surgical oncology several studies have already revealed that a minimally invasive approach provides at least the same, if not a better, long-term outcome. One could hypothesize that a less invasive approach such as NOTES could further enhance such advantages. Since its initial description, NOTES has become clinical reality and today nearly every organ is accessible by a transluminal approach, in at least the experimental setting. Subsequent to published research, first clinical studies on NOTES in oncology were reported and the accuracy of transgastric peritoneoscopy for staging of pancreas cancer was shown to be similar to laparoscopy in humans. A NOTES gastro-jejunostomy via transgastric access has also been proposed to decrease invasiveness of palliative treatment of duodenal, biliary and pancreatic cancers. Colorectal cancer resection via transanal access would offer a clear-cut patient advantage over laparoscopic and would not be subject to the frequent criticism of violating an innocent second organ, as the colon or rectum is always breached in a colectomy. Natural orifice endoluminal therapies, such as endoscopic submucosal dissection, already have been clinically applied for several years. Improved techniques or instruments evolving from NOTES technology might enhance its widespread use for the treatment of early malignancies and thereby again will provide a tremendous benefit for the patient. Although still somewhat controversial, the subject of natural orifice surgery in oncological disease indicates that current laboratory efforts to introduce NOTES into cancer surgery could be ready for cautious clinical investigations. The final determination of patient benefit will need well-constructed prospective study.
经自然腔道内镜手术（NOTES）是一种新的概念，旨在减轻手术对患者的影响。在肿瘤外科领域，多项研究已经表明，微创方法至少可以提供相同的、甚至更好的长期效果。人们可以假设，像 NOTES 这样的微创方法可以进一步增强这些优势。自最初描述以来，NOTES 已成为临床现实，如今，几乎每个器官都可以通过经腔道途径进入，至少在实验环境中是这样。在发表相关研究之后，首先报道了 NOTES 在肿瘤学中的临床研究，经胃腹膜内镜检查对胰腺癌分期的准确性与人类腹腔镜检查相似。还提出了经胃途径 NOTES 胃空肠吻合术，以减少十二指肠、胆道和胰腺癌的姑息性治疗的侵袭性。经肛门结直肠切除术可为患者提供明显优势，优于腹腔镜手术，并且不会像结肠切除术那样经常受到侵犯无辜第二器官的批评。经自然腔道内镜治疗，如内镜黏膜下剥离术，已经在临床上应用了多年。来自 NOTES 技术的改进技术或器械可能会增强其对早期恶性肿瘤的广泛应用，并再次为患者带来巨大益处。尽管仍存在一些争议，但肿瘤疾病的自然腔道手术这一主题表明，目前将 NOTES 引入癌症手术的实验室努力可能已经为谨慎的临床研究做好了准备。最终确定患者受益需要精心设计的前瞻性研究。
