Pompeu Bernardo F, Mara Vieira Rocha Victória, Machado Oliveira Ana Flávia, Marcolin Patricia, Dos Lucio Generoso Luís C, Mazzola Poli De Figueiredo Sérgio, Formiga Fernanda B
General and Colorectal Surgery, University of São Caetano do Sul, São Paulo, BRA.
Colorectal Surgery, Hospital Heliópolis, São Paulo, BRA.
Cureus. 2025 May 15;17(5):e84191. doi: 10.7759/cureus.84191. eCollection 2025 May.
Minimally invasive surgery is the standard approach for right-sided colon cancer, but conventional laparoscopic specimen extraction (CVT) requires additional abdominal incisions, increasing the risk of postoperative complications and delayed recovery. Natural orifice specimen extraction (NOSE) minimizes abdominal incisions, potentially improving patient outcomes. This meta-analysis compares NOSE and CVT in terms of postoperative complications, operative characteristics, and long-term outcomes. A comprehensive literature search was conducted in PubMed, Scopus, the Cochrane Central Register of Clinical Trials, and Web of Science for studies available up to December 2024. A random-effects model was applied to compute ORs and mean differences (MDs) with 95% CIs. Heterogeneity was evaluated using the I² statistic. All statistical analyses were performed using R software (version 4.4.1, R Foundation for Statistical Computing). Seven propensity score-matched studies with 566 patients were included, with 240 (42.4%) undergoing NOSE and 326 (57.6%) undergoing CVT. NOSE was associated with significantly reduced postoperative pain on the 3rd day (MD -1.1; 95% CI -1.7 to -0.5; p < 0.01), lower SSI rates (OR 0.23; 95% CI 0.08-0.73; p = 0.012), and a shorter time to pass flatus (MD -0.8; 95% CI -1.2 to -0.4; p < 0.01). However, NOSE was linked to longer operative times (MD 36.4 minutes; 95% CI 3.4-69.4; p = 0.03). No significant differences were found in hospital stay (MD -0.5 days; 95% CI -2.1 to 1.1; p = 0.57), blood loss (MD -2.1; 95% CI -9.6 to 5.4; p = 0.58), or local recurrence (OR 0.44; 95% CI 0.07-3.01; p = 0.405). In conclusion, NOSE offers advantages such as reduced postoperative pain, lower SSI rates, and faster bowel recovery, with prolonged operative time as its main limitation. These findings support NOSE as a viable alternative to CVT for right-sided colon cancer without compromising safety or long-term outcomes.
微创手术是右侧结肠癌的标准治疗方法，但传统腹腔镜标本取出术（CVT）需要额外的腹部切口，这增加了术后并发症的风险和恢复时间。经自然腔道标本取出术（NOSE）可将腹部切口减至最少，有可能改善患者的治疗效果。本荟萃分析比较了NOSE和CVT在术后并发症、手术特征和长期疗效方面的差异。我们在PubMed、Scopus、Cochrane临床试验中心注册库和Web of Science上进行了全面的文献检索，以查找截至2024年12月的相关研究。采用随机效应模型计算比值比（OR）和平均差（MD），并给出95%置信区间（CI）。使用I²统计量评估异质性。所有统计分析均使用R软件（版本4.4.1，R统计计算基金会）进行。纳入了7项倾向评分匹配研究，共566例患者，其中240例（42.4%）接受了NOSE，326例（57.6%）接受了CVT。NOSE与术后第3天疼痛显著减轻相关（MD -1.1；95% CI -1.7至-0.5；p < 0.01），手术部位感染率较低（OR 0.23；95% CI 0.08 - 0.73；p = 0.012），以及排气时间缩短（MD -0.8；95% CI -1.2至-0.4；p < 0.01）。然而，NOSE与手术时间延长有关（MD 36.4分钟；95% CI 3.4 - 69.4；p = 0.03）。在住院时间（MD -0.5天；95% CI -2.1至1.1；p = 0.57）、失血量（MD -2.1；95% CI -9.6至5.4；p = 0.58）或局部复发方面未发现显著差异（OR 0.44；95% CI 0.07 - 3.01；p = 0.405）。总之，NOSE具有术后疼痛减轻、手术部位感染率降低和肠道恢复更快等优点，主要局限性是手术时间延长。这些研究结果支持NOSE作为CVT的可行替代方案用于右侧结肠癌，且不影响安全性或长期疗效。
