Department of Colon and Rectal Surgery, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China.
Department of Surgery, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, People's Republic of China.
Gastrointest Endosc. 2021 Sep;94(3):642-650. doi: 10.1016/j.gie.2021.03.028. Epub 2021 Mar 31.
Now that the debate about the safety and effectiveness of laparoscopic versus open surgery is over, attention has turned to innovations that can verify whether minimizing the impact of laparoscopy on the abdominal wall can further reduce pain, improve patient comfort, lead to superior cosmesis, and reduce morbidity. The aim of this study was to further explore the application value of totally laparoscopic right hemicolectomy with transcolonic natural orifice specimen extraction (NOSE) and to evaluate the short-term efficacy of transcolonic NOSE surgery for resecting specimens of ascending colon cancer.
From January 2016 to May 2017, a retrospective study was conducted in Guangxi. Propensity score matching was used to minimize the bias from nonrandomized treatment assignment. Patients were followed up through May 2020.
Forty-nine patients underwent totally laparoscopic right hemicolectomy with transcolonic NOSE and 116 patients laparoscopic right hemicolectomy with mini-laparotomy (ML) procedures at our institution. After propensity score matching, each group included 45 patients, and all covariate imbalances were alleviated. The transcolonic NOSE group and the ML group did not differ significantly in terms of baseline clinical characteristics. The transcolonic NOSE group was associated with a shorter time to first flatus (NOSE vs ML: 1.8 ± .5 vs 3.2 ± .8, P = .032), a shorter length of hospital stay (11.3 ± 2.5 days vs 13.0 ± 3.1 days, P = .034), a shorter time to first liquid intake (2.6 ± .8 vs 3.8 ± .9, P = .068), less pain (1.8 ± .8 vs 4.2 ± .7, P = .013), less analgesia requirement (6 [13.3%] vs 21 [46.7%], P = .001), and lower C-reactive protein levels on postoperative day 1 (3.6 ± 1.7 vs 8.2 ± 2.2, P = .001) and postoperative day 3 (NOSE 2.4 ± 1.4 vs M: 4.6 ± 1.7 [P = .013]) than the ML group. The median follow-up was 28.4 months (interquartile range, 18.0-36.0). The 3-year overall survival rates were similar between the transcolonic NOSE group and the ML group.
In total, laparoscopic right hemicolectomy with transcolonic specimen extraction appears to be safe for selected patients with ascending colon cancer as a minimally invasive surgery.
腹腔镜与开腹手术的安全性和有效性的争论已经结束，现在人们的注意力转向了创新，这些创新可以验证是否可以最小化腹腔镜对腹壁的影响，从而进一步减轻疼痛、提高患者舒适度、实现更好的美容效果并降低发病率。本研究的目的是进一步探讨经结肠自然腔道取标本（NOSE）完全腹腔镜右半结肠切除术的应用价值，并评估经结肠 NOSE 手术切除升结肠癌标本的短期疗效。
2016 年 1 月至 2017 年 5 月，在广西进行了一项回顾性研究。采用倾向评分匹配法尽量减少非随机治疗分配引起的偏倚。随访至 2020 年 5 月。
我院 49 例行经结肠 NOSE 完全腹腔镜右半结肠切除术，116 例行腹腔镜右半结肠切除术联合小切口（ML）。经过倾向评分匹配后，每组各有 45 例患者，所有协变量的不平衡均得到缓解。经结肠 NOSE 组与 ML 组在基线临床特征方面无显著差异。经结肠 NOSE 组首次排气时间（NOSE 比 ML：1.8 ±.5 比 3.2 ±.8，P=.032）、住院时间（NOSE 比 ML：11.3 ± 2.5 天比 13.0 ± 3.1 天，P=.034）、首次饮水时间（2.6 ±.8 比 3.8 ±.9，P=.068）更短、疼痛程度较轻（NOSE 比 ML：1.8 ±.8 比 4.2 ±.7，P=.013）、镇痛需求较少（6 [13.3%] 比 21 [46.7%]，P=.001）、术后第 1 天（NOSE 比 ML：3.6 ± 1.7 比 8.2 ± 2.2，P=.001）和第 3 天（2.4 ± 1.4 比 4.6 ± 1.7，P=.013）C 反应蛋白水平较低。中位随访时间为 28.4 个月（四分位距，18.0-36.0）。经结肠 NOSE 组与 ML 组的 3 年总生存率无差异。
对于选定的升结肠癌患者，经结肠标本提取的完全腹腔镜右半结肠切除术总体上似乎是一种安全的微创手术。
