Zheng Shuai, Cao Meiran, Zheng Honghong, Li Jianjun, Yang Ji, Zhao Enhong
Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.
Department of Nephrology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.
Wideochir Inne Tech Maloinwazyjne. 2023 Mar;18(1):135-143. doi: 10.5114/wiitm.2022.119238. Epub 2022 Sep 4.
Complete laparoscopic radical resection of colorectal cancer without incision anastomosis is performed by means of natural orifice specimen extraction (NOSE), which avoids a large abdominal wall incision. Although this procedure is increasingly practiced, it is still underdeveloped, one reason being that controversy still exists regarding bacteriological and oncological safety.
To demonstrate the safety of complete laparoscopic radical resection of colorectal cancer without incision anastomosis in bacteriology and oncology.
This study was a retrospective study with prospectively collected data. This study continuously collected 420 patients who underwent colorectal cancer surgery in our hospital from January 2018 to March 2022. According to the different surgical methods, they were divided into the NOSE group (the natural orifice specimen extraction group) and the N-NOSE group (specimen removed through abdominal wall auxiliary incision). The two groups were matched 1 : 1 using the propensity score matching (PSM) method to balance at baseline. Bacteriological and oncological outcomes, short-term complications, and long-term prognosis were compared between the two groups.
One hundred and eighty-four of the 420 included patients were successfully matched. The differences in gender, body mass index, T stage, N stage, and diabetes status between the two groups after matching were not statistically significant. There were no significant differences in oncological outcomes, short-term complications, and 2-year postoperative disease-free survival between the two groups. There was no significant correlation between positive bacterial culture results and intra-abdominal infection.
Compared with traditional laparoscopic surgery, complete laparoscopic radical resection of colorectal cancer without incision anastomosis has satisfactory bacteriological and oncological effects and is worthy of further clinical promotion.
结直肠癌完全腹腔镜根治性切除且无切口吻合术是通过自然腔道标本取出术（NOSE）进行的，该方法避免了腹壁大切口。尽管这种手术越来越多地被应用，但仍不够成熟，原因之一是在细菌学和肿瘤学安全性方面仍存在争议。
证明结直肠癌完全腹腔镜根治性切除且无切口吻合术在细菌学和肿瘤学方面的安全性。
本研究是一项回顾性研究，数据前瞻性收集。本研究连续收集了2018年1月至2022年3月在我院接受结直肠癌手术的420例患者。根据手术方式不同，将其分为NOSE组（自然腔道标本取出组）和N-NOSE组（经腹壁辅助切口取出标本）。采用倾向评分匹配（PSM）方法将两组1:1匹配，以在基线时达到平衡。比较两组的细菌学和肿瘤学结局、短期并发症及长期预后。
420例纳入患者中有184例成功匹配。匹配后两组在性别、体重指数、T分期、N分期和糖尿病状态方面的差异无统计学意义。两组在肿瘤学结局、短期并发症及术后2年无病生存率方面无显著差异。细菌培养阳性结果与腹腔内感染之间无显著相关性。
与传统腹腔镜手术相比，结直肠癌完全腹腔镜根治性切除且无切口吻合术具有满意的细菌学和肿瘤学效果，值得进一步临床推广。
