Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1527-1536
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1527
Perioperative outcomes of transvaginal specimen extraction laparoscopic total gastrectomy and conventional laparoscopic-assisted total gastrectomy
Zhi-Cao Zhang, Wen-Sheng Wang, Jiang-Hong Chen, Yuan-Hang Ma, Qi-Fa Luo, Yun-Bo Li, Yang Yang, Dan Ma
Zhi-Cao Zhang, Wen-Sheng Wang, Jiang-Hong Chen, Yuan-Hang Ma, Qi-Fa Luo, Yun-Bo Li, Yang Yang, Dan Ma, Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
Author contributions: Zhang ZC and Ma D contributed to the conceptualization; Zhang ZC contributed to the data collation, statistics, surgery, and manuscript writing; Wang WS, Chen JH, Ma YH, and Ma D contributed to the formal analysis, and visualization; Wang WS, Chen JH, and Ma YH contributed to the follow-up visit data curation; Ma D contributed to the funding acquisition, project administration, supervision, and writing - review & editing; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committees of Second Affiliated Hospital of Army Medical University, PLA.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that there is no conflict of interest.
Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Dan Ma, Doctor, MD, Associate Chief Physician, Associate Professor, Department of General Surgery, Xinqiao Hospital of Army Medical University, No. 83 Xinqiao Main Street, Shapingba District, Chongqing 400037, China. 1054727918@qq.com
Received: January 16, 2024
Revised: February 20, 2024
Accepted: May 24, 2024
Published online: June 27, 2024
Processing time: 165 Days and 22 Hours
Abstract
BACKGROUND

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.

AIM

To discuss the postoperative effects of two different surgical methods in patients with GC.

METHODS

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 (n = 22) and LATG group (n = 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.

RESULTS

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 (P < 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.

CONCLUSION

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.

Keywords: Gastric cancer; Circular stapler; Natural orifice specimen extraction surgery; Laparoscopic-assisted total gastrectomy

Core Tip: Natural orifice specimen extraction surgery (NOSES) in laparoscopic-assisted total gastrectomy (LATG) has a reduced requirement for abdominal incision and associated complications, decreased pain and discomfort, and improved postoperative recovery. The combined use of dual circular staplers in Roux-en-Y digestive tract reconstruction in LATG has a lower incidence of postoperative stenosis complications. 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. NOSES has emerged as a promising alternative compared to conventional LATG for treating gastric cancer.