Natural Orifice Specimen Extraction Surgery versus Conventional Laparoscopic-Assisted Resection in the Treatment of Colorectal Cancer: A Propensity-Score Matching Study

Abstract

Qingchao Tang,1 Yihao Zhu,1 Huan Xiong,1 Xiangzong Sheng,1 Zhiqiao Hu,1 Hanqing Hu,1 Rui Huang,1 Qian Zhang,1 Ziming Yuan,1 Lei Xie,2 Zhifeng Gao,1 Yuliuming Wang,1 Guiyu Wang,1 Xishan Wang3 1Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 2Heilongjiang Agricultural Reclamation General Hospital, Harbin, People’s Republic of China; 3Department 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, People’s Republic of ChinaCorrespondence: Xishan WangDepartment of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing, People’s Republic of ChinaTel [phone]Email [email protected] WangDepartment of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Harbin, People’s Republic of ChinaTel [phone]Email [email protected]: Natural orifice specimen extraction surgery (NOSES) has been successfully applied to the treatment of gastric, colorectal cancer (CRC). However, the development of NOSES is still in the exploratory stage, and there is still no strong evidence-based medical evidence.Patients and Methods: From January 2013 to June 2017, consecutive patients with colorectal cancer who underwent transluminal resection, anastomosis, and specimen extraction and those who underwent conventional laparoscopic resection were enrolled. Propensity score matching was used to align clinicopathological features between the two groups.Results: A total of 372 patients were eventually included in this study, 186 in each group. According to perioperative information and postoperative follow-up in both groups, the NOSES group had less blood loss (P = 0.011), shorter time to recovery of gastrointestinal function (P < 0.001), shorter postoperative hospital stay (P = 0.037). The NOSES group had fewer postoperative analgesics (P < 0.001), lower postoperative pain scores (P < 0.001), and lower incidence of postoperative complications (P = 0.017). Compared with the LA (laparoscopic) group, the NOSES group had better physical function (P< 0.05), role function (P< 0.001), emotional function (P< 0.001) and global health status than LA group, while symptoms such as pain (P< 0.001), insomnia (P< 0.001), constipation (P< 0.001) and diarrhea (P< 0.05) were less severe in the NOSES group. In addition, the NOSES group had higher body image scores. Overall survival (OS) and disease-free survival (DFS) were not significantly different between the two groups.Conclusion: For surgical treatment of colorectal cancer, NOSES has advantages in reducing postoperative pain, recovery of gastrointestinal function, postoperative quality of life, and improving patients’ satisfaction with abdominal wall aesthetics. There was no difference in long-term survival between NOSES and conventional laparoscopic surgery.Keywords: colorectal cancer, laparoscopic surgery, perioperative efficacy, natural orifice specimen extraction, survival

Keywords

• colorectal cancer
• laparoscopic surgery
• perioperative efficacy
• natural orifice specimen extraction
• survival.