Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, China Medical University, No. 2, Yu-Der Rd, Taichung, 404, Taiwan.
Department of Life Sciences, National Chung Hsing University, No.145, Rd. Xingda, Taichung, Taiwan.
Surg Endosc. 2022 Jan;36(1):155-166. doi: 10.1007/s00464-020-08250-8. Epub 2021 Feb 2.
Although reduced port laparoscopic surgery (RPLS), defined as laparoscopic surgery performed with the minimum possible number of ports and/or small-sized ports, is less invasive than conventional laparoscopic surgery by reducing the number of surgical wounds, an extension of the incision is still needed for specimen extraction, which can undermine the merits of RPLS.
To determine the impact of natural orifice specimen extraction (NOSE) in patients undergoing RPLS for colorectal cancer. The endpoints were perioperative outcome and oncologic safety at 3 years.
Single-center experience (2013-2019).
We retrospectively analyzed our prospectively collected patient records (American Joint Committee on Cancer (AJCC) stage I-III sigmoid or upper rectal cancer (tumor diameter ≤ 5 cm) who underwent curative anterior resection via RPLS. We excluded patients who did not undergo intestinal anastomosis.
Perioperative and oncologic outcomes were compared between patients undergoing natural orifice (RPLS-NOSE) or conventional (mini-laparotomy) specimen extraction (RPLS-CSE). Patients were matched by propensity scores 1:1 for tumor diameter, AJCC stage, American Society of Anesthesiologists score and tumor location.
Of 119 eligible patients, 104 were matched (52 RPLS-NOSE; 52 RPLS-CSE) by propensity scores. Compared with RPLS-CSE, RPLS-NOSE was associated with longer operative time (223.9 vs. 188.7 min; p = 0.003), decreased use of analgesics (morphine dose 33.9 vs. 43.4 mg; p = 0.011) and duration of hospital stay (4.2 vs. 5.1 days; p = 0.001). No statistically significant difference was found in morbidity or wound-related complication rates between the two groups. After a median follow-up of 34.3 months, no local recurrence was observed in RPLS-NOSE. The 3-year disease-free survival did not differ statistically significantly between groups (90.9 vs. 90.5%; p = 0.610).
NOSE enhances the advantages of RPLS by avoiding the need for abdominal wall specimen extraction in patients with tumor diameter ≤ 5 cm. Surgical and oncologic safety are comparable to RPLS with CSE.
与传统腹腔镜手术相比，经皮腹腔镜手术（RPLS）的创伤更小，定义为通过减少手术切口数量和/或使用小尺寸切口进行的腹腔镜手术。然而，为了取出标本，仍然需要延长切口，这可能会破坏 RPLS 的优点。
确定在接受结直肠 RPLS 治疗的患者中进行自然腔道标本提取（NOSE）的影响。研究终点为术后 3 年的围手术期结果和肿瘤安全性。
单中心经验（2013-2019 年）。
我们回顾性分析了前瞻性收集的患者记录（美国癌症联合委员会（AJCC）I-III 期乙状结肠或直肠上段癌（肿瘤直径≤5cm），通过 RPLS 行根治性前切除术。我们排除了未行肠吻合术的患者。
比较接受自然腔道（RPLS-NOSE）或常规（小切口）标本提取（RPLS-CSE）的患者的围手术期和肿瘤学结果。通过肿瘤直径、AJCC 分期、美国麻醉医师协会评分和肿瘤位置的倾向评分进行 1:1 匹配。
在 119 名符合条件的患者中，通过倾向评分匹配了 104 名患者（52 名 RPLS-NOSE；52 名 RPLS-CSE）。与 RPLS-CSE 相比，RPLS-NOSE 手术时间更长（223.9 与 188.7min；p=0.003），镇痛药使用量减少（吗啡剂量 33.9 与 43.4mg；p=0.011），住院时间缩短（4.2 与 5.1d；p=0.001）。两组之间的发病率或与伤口相关的并发症发生率无统计学差异。中位随访 34.3 个月后，RPLS-NOSE 组未观察到局部复发。两组 3 年无病生存率无统计学差异（90.9%与 90.5%；p=0.610）。
对于肿瘤直径≤5cm 的患者，NOSE 通过避免腹壁标本提取，增强了 RPLS 的优势。手术和肿瘤学安全性与 RPLS 联合 CSE 相当。
