Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Rep (Hoboken). 2024 May;7(5):e2003. doi: 10.1002/cnr2.2003.
Mid-rectal cancer treatment traditionally involves conventional laparoscopic-assisted resection (CLAR). This study aimed to assess the clinical and therapeutic advantages of Natural Orifice Specimen Extraction Surgery (NOSES) over CLAR.
To compare the clinical outcomes, intraoperative metrics, postoperative recovery, complications, and long-term prognosis between NOSES and CLAR groups.
MATERIALS & METHODS: A total of 136 patients were analyzed, with 92 undergoing CLAR and 44 undergoing NOSES. Clinical outcomes were evaluated, and propensity score matching (PSM) was employed to control potential biases.
The NOSES group exhibited significant improvements in postoperative recovery, including lower pain scores on days 1, 3, and 5 (p < .001), reduced need for additional analgesics (p = .02), shorter hospital stays (10.8 ± 2.3 vs. 14.2 ± 5.3 days; p < .001), and decreased intraoperative blood loss (48.1 ± 52.7 mL vs. 71.0 ± 55.0 mL; p = .03). Patients undergoing NOSES also reported enhanced satisfaction with postoperative abdominal appearance and better quality of life. Additionally, the NOSES approach resulted in fewer postoperative complications.
While long-term outcomes (overall survival, disease-free survival, and local recurrence rates) were comparable between the two methods, NOSES demonstrated superior postoperative outcomes compared to CLAR in mid-rectal cancer treatment, while maintaining similar long-term oncological safety. These findings suggest that NOSES could serve as an effective alternative to CLAR without compromising long-term results.
中直肠癌症的传统治疗方法涉及传统腹腔镜辅助切除术（CLAR）。本研究旨在评估自然腔道标本取出术（NOSES）相对于 CLAR 的临床和治疗优势。
比较 NOSES 和 CLAR 组的临床结果、术中指标、术后恢复、并发症和长期预后。
共分析了 136 例患者，其中 92 例行 CLAR，44 例行 NOSES。评估了临床结果，并采用倾向评分匹配（PSM）来控制潜在的偏倚。
NOSES 组在术后恢复方面表现出显著改善，包括第 1、3 和 5 天的疼痛评分更低（p <.001）、需要额外镇痛药物的次数减少（p =.02）、住院时间更短（10.8 ± 2.3 天 vs. 14.2 ± 5.3 天；p <.001）和术中出血量减少（48.1 ± 52.7 毫升 vs. 71.0 ± 55.0 毫升；p =.03）。NOSES 组患者还报告对术后腹部外观和生活质量的满意度更高。此外，NOSES 方法导致的术后并发症更少。
尽管两种方法的长期结果（总生存率、无病生存率和局部复发率）相当，但与 CLAR 相比，NOSES 在中直肠癌症治疗中显示出更好的术后结果，同时保持类似的长期肿瘤学安全性。这些发现表明，NOSES 可以作为 CLAR 的有效替代方法，而不会影响长期结果。
