Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Eur J Surg Oncol. 2020 Oct;46(10 Pt B):e55-e61. doi: 10.1016/j.ejso.2020.06.023. Epub 2020 Jul 14.
The aim of this study was to evaluate the safety of natural orifice specimen extraction surgery (NOSES) and to compare the short- and long-term outcomes of three techniques of NOSES for rectal cancer (RC).
A consecutive series of RC patients in stage I-III who underwent laparoscopic NOSES were enrolled. Three main techniques of NOSES included specimen eversion and extra-abdominal resection (EVER), specimen extraction and extra-abdominal resection (EXER) and intra-abdominal resection and specimen extraction (IREX). The postoperative complications, 5-year disease free survival (DFS), 5-year local recurrence rate (LRR) and 5-year distant metastasis rate (DMR) were compared in three techniques.
268 RC patients met inclusion criteria, including 83 patients treated with EVER, 75 patients treated with EXER and 110 patients treated with IREX. Tumor location was the most critical factor associated with technique selection, with P < 0.001. Postoperative complication rate was 12.3% for all patients, and it was 18.1% for EVER, 13.3% for EXER and 7.3% for IREX. There were no significant differences for anastomotic leakage, anastomotic bleeding and intraabdominal abscess among three technique groups, with P > 0.05. For long-term outcomes, the 5-year DFS, 5-year LRR and 5-year DMR were 85.03%, 4.22% and 11.00% for all patients. Patients in advanced tumor stage have worse long-term survival compared with patients in early stage, but no significant survival differences were observed among three technique groups.
Three techniques of NOSES for RC had acceptable short- and long-term outcomes, and tumor location was a determinant of technique selection.
本研究旨在评估经自然腔道取标本手术（NOSES）的安全性，并比较三种直肠（RC）NOSES 技术的短期和长期结果。
纳入了连续系列的 I-III 期 RC 患者，他们接受了腹腔镜下 NOSES。NOSES 的三种主要技术包括标本外翻和腹腔外切除（EVER）、标本提取和腹腔外切除（EXER）和腹腔内切除和标本提取（IREX）。比较了三种技术的术后并发症、5 年无病生存率（DFS）、5 年局部复发率（LRR）和 5 年远处转移率（DMR）。
268 例 RC 患者符合纳入标准，包括 83 例 EVER 治疗患者、75 例 EXER 治疗患者和 110 例 IREX 治疗患者。肿瘤位置是与技术选择最相关的关键因素，P<0.001。所有患者的术后并发症发生率为 12.3%，其中 EVER 为 18.1%，EXER 为 13.3%，IREX 为 7.3%。三组之间吻合口漏、吻合口出血和腹腔脓肿无显著差异，P>0.05。长期结果显示，所有患者的 5 年 DFS、5 年 LRR 和 5 年 DMR 分别为 85.03%、4.22%和 11.00%。晚期肿瘤患者的长期生存率较早期患者差，但三组之间无显著生存差异。
三种 RC-NOSES 技术具有可接受的短期和长期结果，肿瘤位置是技术选择的决定因素。
