Published online Jan 26, 2019. doi: 10.12998/wjcc.v7.i2.122
Peer-review started: October 19, 2018
First decision: November 27, 2018
Revised: December 18, 2018
Accepted: January 3, 2019
Article in press: January 3, 2019
Published online: January 26, 2019
Processing time: 99 Days and 21.7 Hours
The purpose of modern surgery is functional and minimally invasive. More attention must be paid to the quality of life after surgery and the aesthetic appearance of the abdominal wall in the current environment. The exploration of completely endoscopic surgery through the natural cavity has never ceased.
This case-control study compared the short-term clinical efficacy of natural orifice specimen extraction surgery (NOSES) and the conventional laparoscopic-assisted approach for low rectal cancer. In the present research, we investigated the expected effect of NOSES.
Our study aimed to further explore the application value and short-term efficacy of NOSES for resecting specimens of low rectal cancer, as well as to provide a theoretical basis for its extensive clinical application.
From June 2015 to June 2018, 108 consecutive laparoscopic-assisted low rectal cancer resections were performed at our center. Among them, 26 specimens were resected transanally using a prolapsing technique (NOSES), and 82 were resected through a conventional abdominal wall small incision (LAP). A propensity score matching method was applied to select 26 pairs of matched patients, and their perioperative data were analyzed. After data matching, the baseline data were comparable between the two matched groups. All 52 patients underwent the surgery successfully.
The operative time, blood loss, number of harvested lymph nodes, postoperative complication rate, circumferential margin involvement, postoperative follow-up data, and postoperative anal function were not statistically significant. And NOSES had advantages in reducing postoperative pain, accelerating recovery, lowering medical costs, and improving the postoperative aesthetic appearance of the abdominal wall.
NOSES for low rectal cancer can achieve satisfactory short-term efficacy. The completion of the NOSES operation requires sterility and no tumor, which requires that the surgeon must have extensive experience and enough operation skills. Surgical indications must be strictly controlled when performing this operation. Otherwise, prolonging the operation time will also increase the incidence of surgical complications.
We will spare no effort to continue the research in this field in future, and we will design high quality randomized controlled trials to explore the long-term efficacy of NOSES.