Zhao Fuqiang, Zhao Wei, Xiao Tixian, Wang Zhijie, Huang Fei, Xing Wei, Liu Qian
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, Beijing, China.
Department of General Surgery, Hebei Province Hospital of Chinese Medicine, Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China.
Front Surg. 2023 Feb 23;10:1078316. doi: 10.3389/fsurg.2023.1078316. eCollection 2023.
Natural orifice specimen extraction surgery (NOSES) has been confirmed as an alternative approach without auxiliary incisions. The purpose of this study was to investigate the short-term and survival outcomes of NOSES versus conventional laparoscopic surgery (LAP) in treatment of sigmoid and high rectal cancer.
The retrospective study was conducted at single centers between January 2017 to December 2021. Relevant data included clinical demographics, pathological features, operative parameters, postoperative complications and survival outcomes were collected and analyzed. All procedures were performed using either a NOSES or a conventional LAP approach. Propensity score matching (PSM) was conducted to balance clinical and pathological features between the two groups.
After PSM, a total of 288 patients were eventually included in this study, 144 in each group. Patients in the NOSES group experienced faster recovery of gastrointestinal function (2.6 ± 0.8 vs. 3.6 ± 0.9 day, = 0.037), less pain and less analgesia required (12.5% vs. 33.3%, < 0.001). In addition, the incidence of surgical site infection in the LAP group was significantly higher than that in the NOSES group (12.5% vs. 4.2%, = 0.011), especially incision-related complications (8.3% vs. 2.1%, = 0.017). After a median follow-up of 32 (range, 3-75) months, the two groups had similar 3-year overall survival rates (88.4% vs. 88.6%; = 0.850) and disease-free survival rates (82.9% vs. 77.2%; = 0.494).
The transrectal NOSES procedure is a well-established strategy with advantages in reducing postoperative pain, faster recovery of gastrointestinal function, and less incision-related complications. In addition, the long-term survival is similar between NOSES and conventional laparoscopic surgery.
经自然腔道取标本手术（NOSES）已被确认为一种无需辅助切口的替代方法。本研究的目的是探讨NOSES与传统腹腔镜手术（LAP）治疗乙状结肠和高位直肠癌的短期及生存结局。
本回顾性研究于2017年1月至2021年12月在单中心进行。收集并分析相关数据，包括临床人口统计学、病理特征、手术参数、术后并发症及生存结局。所有手术均采用NOSES或传统LAP方法进行。采用倾向评分匹配（PSM）来平衡两组之间的临床和病理特征。
经过PSM后，本研究最终纳入288例患者，每组144例。NOSES组患者的胃肠功能恢复更快（2.6±0.8天 vs. 3.6±0.9天，P = 0.037），疼痛更轻且所需镇痛更少（12.5% vs. 33.3%，P < 0.001）。此外，LAP组手术部位感染的发生率显著高于NOSES组（12.5% vs. 4.2%，P = 0.011），尤其是切口相关并发症（8.3% vs. 2.1%，P = 0.017）。中位随访32（范围3 - 75）个月后，两组的3年总生存率相似（88.4% vs. 88.6%；P = 0.850），无病生存率也相似（82.9% vs. 77.2%；P = 0.494）。
经直肠NOSES手术是一种成熟的策略，在减轻术后疼痛、加快胃肠功能恢复及减少切口相关并发症方面具有优势。此外，NOSES与传统腹腔镜手术的长期生存率相似。
