Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2142-2153
Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2142
Robotic natural orifice specimen extraction surgery I-type F method vs conventional robotic resection for lower rectal cancer
Fang Tao, Dong-Ning Liu, Peng-Hui He, Xin Luo, Chi-Ying Xu, Tai-Yuan Li, Jin-Yuan Duan
Fang Tao, Dong-Ning Liu, Xin Luo, Chi-Ying Xu, Tai-Yuan Li, Jin-Yuan Duan, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330052, Jiangxi Province, China
Peng-Hui He, Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330052, Jiangxi Province, China
Author contributions: Tao F, Li TY and Duan JY designed the study and reviewed the data; Tao F and Xu CY performed the acquisition of clinical data; Tao F drafting of manuscript; Duan JY and Liu DN critical revision of manuscript; Luo X and He PH data analysis; Luo X figure and video production; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81860519.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University.
Informed consent statement: Patients were not required to give informed consent for this study, as it is a retrospective clinical study and the analysis used previous clinical data. All patients signed an informed consent form before surgery.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Yuan Duan, MD, Associate Chief Physician, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, No. 1519 Dongyue Avenue, Nanchang 330052, Jiangxi Province, China. duanjy2022@outlook.com
Received: March 11, 2023
Peer-review started: March 11, 2023
First decision: June 14, 2023
Revised: July 4, 2023
Accepted: August 18, 2023
Article in press: August 18, 2023
Published online: October 27, 2023
Processing time: 230 Days and 0.2 Hours
Abstract
BACKGROUND

Robotic resection using the natural orifice specimen extraction surgery I-type F method (R-NOSES I-F) is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer. However, the current literature on this method is limited to case reports, and further investigation into its safety and feasibility is warranted.

AIM

To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.

METHODS

From September 2018 to February 2022, 206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis. Of these patients, 22 underwent R-NOSES I-F surgery (R-NOSES I-F group) and 76 underwent conventional robotic-assisted low rectal cancer resection (RLRC group). Clinicopathological data of all patients were collected and analyzed. Postoperative outcomes and prognoses were compared between the two groups. Statistical analysis was performed using SPSS software.

RESULTS

Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1 (1.7 ± 0.7 vs 2.2 ± 0.6, P = 0.003) and shorter postoperative anal venting time (2.7 ± 0.6 vs 3.5 ± 0.7, P < 0.001) than those in the RLRC group. There were no significant differences between the two groups in terms of sex, age, body mass index, tumor size, TNM stage, operative time, intraoperative bleeding, postoperative complications, or inflammatory response (P > 0.05). Postoperative anal and urinary functions, as assessed by Wexner, low anterior resection syndrome, and International Prostate Symptom Scale scores, were similar in both groups (P > 0.05). Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups (P > 0.05).

CONCLUSION

R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer. It improves pain relief, promotes gastrointestinal function recovery, and helps avoid incision-related complications.

Keywords: Robotic surgery; Natural orifice specimen extraction surgery; Lower rectal cancer; Robotic resection using the natural orifice specimen extraction surgery I-type F method

Core Tip: This retrospective study examined the efficacy and safety of a novel surgical procedure called robotic resection using the natural orifice specimen extraction surgery I-type F method (R-NOSES I-F) for lower rectal cancer. Through a comparison with robotic-assisted low rectal cancer resection, the study demonstrates that R-NOSES I-F is a safe and effective minimally invasive surgical approach for low rectal cancer. It offers several benefits, including decreased postoperative pain, improved gastrointestinal function recovery, reduced abdominal wall dysfunction, and avoidance of complications associated with abdominal wall incisions. Furthermore, R-NOSES I-F does not negatively impact anal and urinary functions and does not increase the risk of local recurrence or distant metastasis.