Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China.
Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China.
Updates Surg. 2022 Jun;74(3):833-842. doi: 10.1007/s13304-022-01276-8. Epub 2022 Mar 18.
Natural orifice specimen extraction surgery (NOSES) is a new technique and uses natural orifice as the delivery route for specimen extraction to avoid supererogatory incision, and the safety and oncological outcomes of NOSES for right hemicolectomy are still inconclusive, so a meta-analysis was performed to compare these to conventional laparoscopic surgery (CLS). Related literature comparing NOSES with CLS for right hemicolectomy, whether randomized controlled trials (RCTs) or retrospective studies, were systematically searched. A random-effect model or fixed-effect model was used based on the I value. A total of six studies (all retrospective trials) involving 609 participants were included. Compared with CLS, NOSES was more preponderant than CLS in terms of surgical morbidity [odds ratio (OR) = 0.31; P = 0.0002], length of hospital stay [weighted mean difference (WMD) = - 1.52; P = 0.006], time to first flatus (WMD = - 0.82; P = 0.0008) and liquid intake (WMD = - 1.40; P < 0.00001), pain score of POD1 (WMD = - 1.99; P < 0.00001) and POD3 (WMD = - 1.15; P = 0.02), and cosmetic result (WMD = 1.84; P < 0.00001), while operative time of NOSES was prolonged (WMD = 18.29; P = 0.04). The number of dissected lymph nodes, recurrence, and 3-year overall survival (3-year OS) in NOSES group were comparable to the CLS group. Despite the lack of enough evidence, NOSES for right hemicolectomy has demonstrated comparable safety and oncological outcomes as CLS with less postoperative morbidity and pain, better cosmetic effect, and rapider recovery.
自然腔道取标本手术（NOSES）是一种新技术，它使用自然腔道作为标本取出的输送途径，避免了额外的切口。NOSES 用于右半结肠切除术的安全性和肿瘤学结果仍不确定，因此进行了荟萃分析，以比较这些与传统腹腔镜手术（CLS）。系统地搜索了比较右半结肠切除术的 NOSES 与 CLS 的相关文献，包括随机对照试验（RCT）和回顾性研究。根据 I 值使用随机效应模型或固定效应模型。共纳入 6 项研究（均为回顾性研究），共 609 名参与者。与 CLS 相比，NOSES 在手术发病率[比值比（OR）=0.31；P=0.0002]、住院时间[加权均数差（WMD）=-1.52；P=0.006]、首次排气时间（WMD=-0.82；P=0.0008）和液体摄入（WMD=-1.40；P<0.00001）、术后第 1 天（POD1）疼痛评分（WMD=-1.99；P<0.00001）和第 3 天（POD3）疼痛评分（WMD=-1.15；P=0.02）、美容效果（WMD=1.84；P<0.00001）方面更具优势，而 NOSES 的手术时间延长（WMD=18.29；P=0.04）。NOSES 组的淋巴结清扫数量、复发率和 3 年总生存率（3 年 OS）与 CLS 组相当。尽管证据不足，但 NOSES 用于右半结肠切除术具有与 CLS 相当的安全性和肿瘤学结果，术后发病率和疼痛更低，美容效果更好，恢复更快。
