Zhang Zhi-Cao, Wang Wen-Sheng, Chen Jiang-Hong, Ma Yuan-Hang, Luo Qi-Fa, Li Yun-Bo, Yang Yang, Ma Dan
Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China.
World J Gastrointest Surg. 2024 Jun 27;16(6):1527-1536. doi: 10.4240/wjgs.v16.i6.1527.
Natural orifice specimen extraction surgery (NOSES) has emerged as a promising alternative compared to conventional laparoscopic-assisted total gastrectomy (LATG) for treating gastric cancer (GC). However, evidence regarding the efficacy and safety of NOSES for GC surgery is limited. This study aimed to compare the safety and feasibility, in addition to postoperative complications of NOSES and LATG.
To discuss the postoperative effects of two different surgical methods in patients with GC.
Dual circular staplers were used in Roux-en-Y digestive tract reconstruction for transvaginal specimen extraction LATG, and its outcomes were compared with LATG in a cohort of 51 GC patients with tumor size ≤ 5 cm. The study was conducted from May 2018 to September 2020, and patients were categorized into the NOSES group ( = 22) and LATG group ( = 29). Perioperative parameters were compared and analyzed, including patient and tumor characteristics, postoperative outcomes, and anastomosis-related complications, postoperative hospital stay, the length of abdominal incision, difference in tumor type, postoperative complications, and postoperative survival.
Postoperative exhaust time, operation duration, mean postoperative hospital stay, length of abdominal incision, number of specific staplers used, and Brief Illness Perception Questionnaire score were significant in both groups ( < 0.01). In the NOSES group, the postoperative time to first flatus, mean postoperative hospital stay, and length of abdominal incision were significantly shorter than those in the LATG group. Patients in the NOSES group had faster postoperative recovery, and achieved abdominal minimally invasive incision that met aesthetic requirements. There were no significant differences in gender, age, tumor type, postoperative complications, and postoperative survival between the two groups.
The application of dual circular staplers in Roux-en-Y digestive tract reconstruction combined with NOSES gastrectomy is safe and convenient. This approach offers better short-term outcomes compared to LATG, while long-term survival rates are comparable to those of conventional laparoscopic surgery.
与传统腹腔镜辅助全胃切除术（LATG）相比，经自然腔道取标本手术（NOSES）已成为治疗胃癌（GC）的一种有前景的替代方法。然而，关于NOSES用于GC手术的疗效和安全性的证据有限。本研究旨在比较NOSES和LATG的安全性和可行性以及术后并发症。
探讨两种不同手术方法对GC患者的术后影响。
在Roux-en-Y消化道重建的经阴道标本取出LATG中使用双圆形吻合器，并将其结果与51例肿瘤大小≤5 cm的GC患者队列中的LATG结果进行比较。该研究于2018年5月至2020年9月进行，患者分为NOSES组（n = 22）和LATG组（n = 29）。比较并分析围手术期参数，包括患者和肿瘤特征、术后结果、吻合口相关并发症、术后住院时间、腹部切口长度、肿瘤类型差异、术后并发症和术后生存率。
两组术后排气时间、手术时长、平均术后住院时间、腹部切口长度、使用的特定吻合器数量和简易疾病感知问卷评分均有显著差异（P < 0.01）。在NOSES组中，术后首次排气时间、平均术后住院时间和腹部切口长度均显著短于LATG组。NOSES组患者术后恢复更快，实现了符合美学要求的腹部微创切口。两组在性别、年龄、肿瘤类型、术后并发症和术后生存率方面无显著差异。
双圆形吻合器在Roux-en-Y消化道重建联合NOSES胃切除术中的应用安全方便。与LATG相比，这种方法提供了更好的短期结果，而长期生存率与传统腹腔镜手术相当。
