Tang Qingchao, Zhu Yihao, Xiong Huan, Sheng Xiangzong, Hu Zhiqiao, Hu Hanqing, Huang Rui, Zhang Qian, Yuan Ziming, Xie Lei, Gao Zhifeng, Wang Yuliuming, Wang Guiyu, Wang Xishan
Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
Heilongjiang Agricultural Reclamation General Hospital, Harbin, People's Republic of China.
Cancer Manag Res. 2021 Mar 9;13:2247-2257. doi: 10.2147/CMAR.S291085. eCollection 2021.
Natural orifice specimen extraction surgery (NOSES) has been successfully applied to the treatment of gastric, colorectal cancer (CRC). However, the development of NOSES is still in the exploratory stage, and there is still no strong evidence-based medical evidence.
From January 2013 to June 2017, consecutive patients with colorectal cancer who underwent transluminal resection, anastomosis, and specimen extraction and those who underwent conventional laparoscopic resection were enrolled. Propensity score matching was used to align clinicopathological features between the two groups.
A total of 372 patients were eventually included in this study, 186 in each group. According to perioperative information and postoperative follow-up in both groups, the NOSES group had less blood loss (P = 0.011), shorter time to recovery of gastrointestinal function (P < 0.001), shorter postoperative hospital stay (P = 0.037). The NOSES group had fewer postoperative analgesics (P < 0.001), lower postoperative pain scores (P < 0.001), and lower incidence of postoperative complications (P = 0.017). Compared with the LA (laparoscopic) group, the NOSES group had better physical function (P<0.05), role function (P<0.001), emotional function (P<0.001) and global health status than LA group, while symptoms such as pain (P<0.001), insomnia (P<0.001), constipation (P<0.001) and diarrhea (P<0.05) were less severe in the NOSES group. In addition, the NOSES group had higher body image scores. Overall survival (OS) and disease-free survival (DFS) were not significantly different between the two groups.
For surgical treatment of colorectal cancer, NOSES has advantages in reducing postoperative pain, recovery of gastrointestinal function, postoperative quality of life, and improving patients' satisfaction with abdominal wall aesthetics. There was no difference in long-term survival between NOSES and conventional laparoscopic surgery.
经自然腔道标本取出手术（NOSES）已成功应用于胃癌、结直肠癌（CRC）的治疗。然而，NOSES的发展仍处于探索阶段，尚无强有力的循证医学证据。
纳入2013年1月至2017年6月期间连续接受经腔镜切除、吻合及标本取出术的结直肠癌患者以及接受传统腹腔镜切除术的患者。采用倾向评分匹配法使两组间的临床病理特征一致。
本研究最终共纳入372例患者，每组186例。根据两组的围手术期信息及术后随访情况，NOSES组术中失血更少（P = 0.011），胃肠功能恢复时间更短（P < 0.001），术后住院时间更短（P = 0.037）。NOSES组术后使用的镇痛药更少（P < 0.001），术后疼痛评分更低（P < 0.001），术后并发症发生率更低（P = 0.017）。与腹腔镜（LA）组相比，NOSES组的身体功能（P<0.05）、角色功能（P<0.001）、情绪功能（P<0.001）及总体健康状况均优于LA组，而NOSES组的疼痛（P<0.001）、失眠（P<0.001）、便秘（P<0.001）及腹泻（P<0.05）等症状较轻。此外，NOSES组的身体形象评分更高。两组的总生存期（OS）和无病生存期（DFS）无显著差异。
对于结直肠癌的手术治疗，NOSES在减轻术后疼痛、促进胃肠功能恢复、提高术后生活质量及改善患者对腹壁美观的满意度方面具有优势。NOSES与传统腹腔镜手术的长期生存率无差异。
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