Liu Rui-Ji, Zhang Chun-Dong, Fan Yu-Chen, Pei Jun-Peng, Zhang Cheng, Dai Dong-Qiu
Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Front Oncol. 2019 Jul 3;9:597. doi: 10.3389/fonc.2019.00597. eCollection 2019.
To evaluate the safety and oncological outcomes of laparoscopic colorectal surgery using natural orifice specimen extraction (NOSE) compared with conventional laparoscopic (CL) colorectal surgery in patients with colorectal diseases. We conducted a systematic search of PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs), prospective non-randomized trials and retrospective trials up to September 1, 2018, and used 5-year disease-free survival (DFS), lymph node harvest, surgical site infection (SSI), anastomotic leakage, and intra-abdominal abscess as the main endpoints. Subgroup analyses were conducted according to the different study types [RCT and NRCT (non-randomized controlled trial)]. A sensitivity analysis was carried out to evaluate the reliability of the outcomes. RevMan5.3 software was used for statistical analysis. Fourteen studies were included (two RCTs, seven retrospective trials and five prospective non-randomized trials) involving a total of 1,435 patients. Compared with CL surgery, the NOSE technique resulted in a shorter hospital stay, shorter time to first flatus, less post-operative pain, and fewer SSIs and total perioperative complications. Anastomotic leakage, blood loss, and intra-abdominal abscess did not differ between the two groups, while operation time was longer in the NOSE group. Oncological outcomes such as proximal margin [weighted mean difference [WMD] = 0.47; 95% confidence interval [CI] -0.49 to 1.42; = 0.34], distal margin (WMD= -0.11; 95% CI -0.66 to 0.45; = 0.70), lymph node harvest (WMD = -0.97; 95% CI -1.97 to 0.03; = 0.06) and 5-year DFS (hazard ratio = 0.84; 95% CI 0.54-1.31; = 0.45) were not different between the NOSE and CL surgery groups. Compared with CL surgery, NOSE may be a safe procedure, and can achieve similar oncological outcomes. Large multicenter RCTs are needed to provide high-level, evidence-based results in NOSE-treated patients and to determine the risk of local recurrence.
评估与传统腹腔镜（CL）结直肠手术相比，采用经自然腔道取标本手术（NOSE）的腹腔镜结直肠手术在结直肠疾病患者中的安全性和肿瘤学结局。我们对PubMed、EMBASE和Cochrane数据库进行了系统检索，纳入截至2018年9月1日的随机对照试验（RCT）、前瞻性非随机试验和回顾性试验，并将5年无病生存期（DFS）、淋巴结清扫数量、手术部位感染（SSI）、吻合口漏和腹腔内脓肿作为主要终点。根据不同的研究类型[RCT和NRCT（非随机对照试验）]进行亚组分析。进行敏感性分析以评估结果的可靠性。使用RevMan5.3软件进行统计分析。共纳入14项研究（2项RCT、7项回顾性试验和5项前瞻性非随机试验），涉及1435例患者。与CL手术相比，NOSE技术可缩短住院时间、缩短首次排气时间、减轻术后疼痛、减少SSI和围手术期总并发症。两组间吻合口漏、失血量和腹腔内脓肿无差异，而NOSE组手术时间更长。NOSE组与CL手术组在肿瘤学结局方面，如近端切缘[加权均数差[WMD]=0.47；95%置信区间[CI]-0.49至1.42；P=0.34]、远端切缘（WMD=-0.11；95%CI-0.66至0.45；P=0.70）、淋巴结清扫数量（WMD=-0.97；95%CI-1.97至0.03；P=0.06）和5年DFS（风险比=0.84；95%CI0.54-1.31；P=0.45）无差异。与CL手术相比。NOSE可能是一种安全的手术方式，并且可以获得相似的肿瘤学结局。需要开展大型多中心RCT，为接受NOSE治疗的患者提供高水平的循证医学结果，并确定局部复发风险。
