Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China.
Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing, 100021, China.
BMC Surg. 2022 Jul 25;22(1):286. doi: 10.1186/s12893-022-01737-2.
Natural orifice specimen extraction surgery (NOSES) has been increasingly applied in radical surgery of abdominal and pelvic organs, but it is still in the exploratory stage. There is insufficient evidence to prove its efficacy.
From January 2013 to June 2017, a total of 351 patients diagnosed with rectal cancer were eventually included in this study. Patients who underwent NOSES were assigned to the NOSES group, while patients undergoing conventional laparoscopic assisted resection were assigned as to the LAP group. Propensity score matching was used to align clinicopathological features between the two groups.
From the perioperative data and postoperative follow-up results of both groups, patients in the NOSES group had less intraoperative bleeding (47.0 ± 60.4 ml vs 87.1 ± 101.2 ml, P = 0.011), shorter postoperative gastrointestinal recovery (50.7 ± 27.3 h vs 58.6 ± 28.5 h, P = 0.040), less postoperative analgesic use (36.8% vs 52.8%, P = 0.019), lower postoperative pain scores (P < 0.001), lower rate of postoperative complications (5.7% vs 15.5%, P = 0.020), more satisfaction with body image (P = 0.001) and cosmesis (P < 0.001) postoperatively. The NOSES group had a higher quality of life. Moreover, there was no significant difference in overall survival (OS) and disease-free survival (DFS) between the two groups.
NOSES could be a safe and reliable technique for radical resection of rectal cancer, with better short-term outcomes than conventional laparoscopy, while long-term survival is not significantly different from that of conventional laparoscopic surgery.
经自然腔道取标本手术（NOSES）已越来越多地应用于腹部和盆腔器官的根治性手术，但仍处于探索阶段。目前尚无充分证据证明其疗效。
本研究共纳入 2013 年 1 月至 2017 年 6 月间诊断为直肠癌的 351 例患者。行 NOSES 手术的患者归入 NOSES 组，行常规腹腔镜辅助切除术的归入 LAP 组。采用倾向评分匹配法对两组的临床病理特征进行均衡。
从两组的围手术期数据和术后随访结果来看，NOSES 组术中出血量较少（47.0±60.4 ml 比 87.1±101.2 ml，P=0.011），术后胃肠功能恢复更快（50.7±27.3 h 比 58.6±28.5 h，P=0.040），术后镇痛药物使用更少（36.8%比 52.8%，P=0.019），术后疼痛评分更低（P<0.001），术后并发症发生率更低（5.7%比 15.5%，P=0.020），术后对体像和美容效果的满意度更高（P=0.001 和 P<0.001）。NOSES 组的生活质量更高。此外，两组的总生存（OS）和无病生存（DFS）无显著差异。
NOSES 是一种安全可靠的直肠癌根治性切除术式，其短期效果优于传统腹腔镜手术，而长期生存与传统腹腔镜手术无显著差异。
