Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
Surg Endosc. 2022 Jan;36(1):222-235. doi: 10.1007/s00464-020-08260-6. Epub 2021 Jan 21.
Laparoscopic surgery with natural orifice specimen extraction (La-NOSE) is being performed more frequently for the minimally invasive management of sigmoid and rectal cancer. The objective of this meta-analysis was to compare the clinical and oncological safety and efficacy of La-NOSE versus conventional laparoscopy (CL).
A search of the PubMed, Web of Science, and Cochrane databases was performed for studies that compared clinical or oncological outcomes of conventional laparoscopic resection using NOSE with conventional laparoscopic resection for sigmoid and rectal cancer.
Compared with CL group, the length of hospital stay and the pain score on the first day were shorter in the La-Nose group. The La-NOSE group had a lower incidence of total perioperative complications (OR 0.46; 95% CI [0.32 to 0.66]; I = 0%; P < 0.0001) and a lower incidence of surgical site infections (SSIs) (OR 0.11; 95% CI [0.04 to 0.29]; I = 0%; P < 0.0001) than the CL group, while the anastomotic leakage showed no significant difference between the La-Nose group and the CL group (P = 0.19). 5-year disease-free survival (DFS) and 5-year overall survival (OS) were no significant difference between the La-Nose group and the CL group (P = 0.43, P = 0.40, respectively).
La-NOSE can achieve oncological and surgical safety comparable to that of CL for patients with sigmoid and rectal cancer. La-NOSE in patients was associated with a shorter hospital stay, shorter time to first flatus or defecation, less postoperative pain, and fewer surgical site infections (SSIs) and total perioperative complications. In general, the operative time in La-NOSE was longer than that in CL. The long-term oncological efficacy of La-NOSE seems to be equivalent to that of CL.
经自然腔道取标本腹腔镜手术（La-NOSE）越来越多地应用于乙状结肠和直肠癌的微创治疗。本荟萃分析的目的是比较 La-NOSE 与传统腹腔镜（CL）在乙状结肠和直肠肿瘤中的临床和肿瘤安全性及有效性。
对 PubMed、Web of Science 和 Cochrane 数据库进行检索，以比较经自然腔道取标本腹腔镜与传统腹腔镜治疗乙状结肠和直肠肿瘤的临床或肿瘤学结局。
与 CL 组相比，La-NOSE 组的住院时间和术后第 1 天的疼痛评分更短。La-NOSE 组的总围手术期并发症发生率较低（OR 0.46；95%CI [0.32 至 0.66]；I=0%；P<0.0001），手术部位感染（SSI）发生率较低（OR 0.11；95%CI [0.04 至 0.29]；I=0%；P<0.0001），而吻合口漏发生率在 La-NOSE 组与 CL 组之间无显著差异（P=0.19）。La-NOSE 组与 CL 组 5 年无病生存率（DFS）和 5 年总生存率（OS）无显著差异（P=0.43，P=0.40）。
La-NOSE 可实现与 CL 相当的肿瘤学和手术安全性，适用于乙状结肠和直肠肿瘤患者。La-NOSE 可使患者住院时间更短、首次排气或排便时间更早、术后疼痛更轻、手术部位感染（SSI）和总围手术期并发症更少。一般来说，La-NOSE 的手术时间长于 CL。La-NOSE 的长期肿瘤学疗效似乎与 CL 相当。
