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Crestani A, Merlot B, Goualard PH, Grigoriadis G, Chanavaz Lacheray I, Dennis T, Roman H. Bowel endometriosis: Surgical customization is demanding. Best Pract Res Clin Obstet Gynaecol 2024; 94:102495. [PMID: 38593673 DOI: 10.1016/j.bpobgyn.2024.102495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Bowel endometriosis is the most common form of severe deep endometriosis. Surgery is an option in case of infertility and/or chronic pain or in the presence of a stenotic lesion. Clinical examination and preoperative imaging must provide an identity card of the lesion so that customized surgery can be proposed. The primary objective of this tailor-made surgery will always be to preserve the organ. The surgeon then has three options: shaving, discoid resection and segmental resection. The more extensive the resection, the greater the risk of severe short- and long-term complications. Surgery must therefore be adapted to the patient's specific situation and needs. Moreover, personalized care must extend beyond surgery. It must begin before the operation, preparing the patient for the operation like an athlete before a race, and continue afterwards by adapting the follow-up to the surgery performed.
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Affiliation(s)
- Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France.
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates
| | - Paul-Henri Goualard
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | | | - Isabelle Chanavaz Lacheray
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Thomas Dennis
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark
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Ianieri MM, De Cicco Nardone A, Greco P, Carcagnì A, Campolo F, Pacelli F, Scambia G, Santullo F. Totally intracorporeal colorectal anastomosis (TICA) versus classical mini-laparotomy for specimen extraction, after segmental bowel resection for deep endometriosis: a single-center experience. Arch Gynecol Obstet 2024:10.1007/s00404-024-07412-6. [PMID: 38512463 DOI: 10.1007/s00404-024-07412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE The surgical approach to bowel endometriosis is still unclear. The aim of the study is to compare TICA to conventional specimen extractions and extra-abdominal insertion of the anvil in terms of both complications and functional outcomes. METHODS This is a single-center, observational, retrospective study conducted enrolling symptomatic women underwent laparoscopic excision of deep endometriosis with segmental bowel resection between September 2019 and June 2022. Women who underwent TICA were compared to classical technique (CT) in terms of intra- and postoperative complications, moreover, functional outcomes relating to the pelvic organs were assessed using validated questionnaires [Knowles-Eccersley-Scott-Symptom (KESS) questionnaire and Gastro-Intestinal Quality of Life Index (GIQLI)] for bowel function. Pain symptoms were assessed using Visual Analogue Scale (VAS) scores. RESULTS The sample included 64 women. TICA was performed on 31.2% (n = 20) of the women, whereas CT was used on 68.8% (n = 44). None of the patients experienced rectovaginal, vesicovaginal, ureteral or vesical fistula, or ureteral stenosis and uroperitoneum, and in no cases was it necessary to reoperate. Regarding the two surgical approaches, no significant difference was observed in terms of complications. As concerns pain symptoms at 6-month follow-up evaluations on stratified data, except for dysuria, all VAS scales reported showed significant reductions between median values, for both surgery interventions. As well, significant improvements were further observed in KESS scores and overall GIQLI. Only the GIQLI evaluation was significantly smaller in the TICA group compared to CT after the 6-month follow-up. CONCLUSIONS We did not find any significant differences in terms of intra- or post-operative complications compared TICA and CT, but only a slight improvement in the Gastro-Intestinal Quality of Life Index in patients who underwent the CT compared to the TICA technique.
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Affiliation(s)
- Manuel Maria Ianieri
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Alessandra De Cicco Nardone
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Antonella Carcagnì
- Catholic University of the Sacred Heart, Rome, Italy
- Epidemiology and Biostatistics Research Core Facility, Gemelli Generator, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Campolo
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Fabio Pacelli
- Catholic University of the Sacred Heart, Rome, Italy
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Unit of Oncological Gynecology, Women's Children's and Public Health Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Santullo
- Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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3
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Xu SZ, Wang ZF, Ding ZJ, Zhang SF, Yuan SB, Yan F, Liu GY, Cai JC. Comparative long-term outcomes of natural orifice specimen extraction surgery and conventional laparoscopic colectomy for left-sided colorectal cancer: a propensity score-matched analysis. Int J Surg 2024; 110:1402-1410. [PMID: 38484259 PMCID: PMC10942156 DOI: 10.1097/js9.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/21/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Natural orifice specimen extraction surgery (NOSES) is currently widely used in left-sided colorectal cancer. Some clinical comparative studies have been conducted, providing evidence of its safety and oncological benefits. However, these studies are typically characterized by small sample sizes and short postoperative follow-up periods. Consequently, in this research, the authors adopt the propensity score matching method to undertake a large-scale retrospective comparative study on NOSES colectomy for left-sided colorectal cancer, with the goal of further augmenting the body of evidence-based medical support for NOSES. METHODS This retrospective study involved patients who underwent NOSES colectomy and conventional laparoscopic (CL) colectomy for left-sided colorectal cancer between January 2014 and April 2021. In the NOSES group, specimens were extracted through the anus with the help of a Cai tube (homemade invention: ZL201410168748.2). The patients were matched at a ratio of 1:1 according to age, sex, BMI, tumor diameter, tumor location (descending and splenic flexure colon/ sigmoid colon/ middle and upper rectum), tumor height from anal verge, ASA grade, previous abdominal surgery, clinical pathologic stage, preoperative CEA. After matching, 132 patients in the NOSES group and 132 patients in the CL group were eligible for analysis. RESULTS Compared with CL group, NOSES group was associated with decreased postoperative maximum pain score (2.6±0.7 vs. 4.7±1.7, P=0.000), less additional analgesia required (6.8 vs. 34.8%, P=0.000), faster time to passage of flatus (2.3±0.6 days vs. 3.3±0.7 days, P=0.000), less wound infection (0.0 vs. 6.1%, P=0.007), and longer operative time (212.5±45.8 min vs. 178.0±43.4 min, P=0.000). No significant differences were observed in estimated blood loss, time to resume regular diet, postoperative hospital stay, conversion to open surgery or conventional minilaparotomy, total morbidity, readmission, mortality, pathologic outcomes, and Wexner incontinence score between groups. After a median follow-up of 63.0 months, the 5-year overall survival rates were 88.3 versus 85.0% (P=0.487), disease-free survival rates were 82.9 versus 83.6% (P=0.824), and the local recurrence rates were 4.4 versus 4.0% (P=0.667) in the NOSES and CL groups, respectively. CONCLUSIONS This study suggests that NOSES colectomy using a Cai tube for left-sided colorectal cancer is a safe and feasible option with better cosmetic results, less pain, faster recovery of gastrointestinal function, and comparable long-term clinical and oncologic outcomes to CL colectomy.
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Affiliation(s)
- Shu-Zhen Xu
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Zhen-Fa Wang
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Zhi-Jie Ding
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Shi-Feng Zhang
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Si-Bo Yuan
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Feng Yan
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Guo-Yan Liu
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Jian-Chun Cai
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
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Seow-En I, Khor SN, Koo CH, Wee IJY, Tan EKW. Transvaginal Natural Orifice Specimen Extraction (NOSE) in Laparoscopic Colorectal Cancer Surgery With New Insights on Technique and Patient Selection. Surg Laparosc Endosc Percutan Tech 2023; 33:571-575. [PMID: 37523505 DOI: 10.1097/sle.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/23/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Following laparoscopic colorectal surgery, transabdominal specimen extraction requires a mini-laparotomy or Pfannenstiel incision, associated with increased postoperative pain and wound complications. The vagina has several unique properties that make natural orifice specimen extraction (NOSE) ideal. We report our experience with transvaginal NOSE for colorectal cancer surgery. MATERIALS AND METHODS A transvaginal sizer allows the posterior vagina to be incised under tension. A transverse or cruciate incision is made, followed by the insertion of a double-ring wound protector. The external ring is opened against the perineum to shorten the length of the conduit for specimen delivery. Vaginotomy closure is performed via laparoscopy using a barbed suture. RESULTS Seventeen consecutive female patients underwent elective colorectal cancer surgery with attempted transvaginal NOSE. Median age and body mass index was 67 (range: 50 to 82) years and 26.5 (range: 19.7 to 35.8) kg/m 2 , respectively. Fourteen patients (82%) underwent left-sided resections and 3 (18%) underwent right-sided resections. Median operating time, blood loss, and length of hospital stay was 245 (range: 155 to 360) minutes, 30 (range: 10 to 500) mL, and 3 (range: 2 to 9) days, respectively. Transvaginal extraction was unsuccessful in 1 (6%) patient. Two (12%) patients experienced early postoperative morbidity, neither attributable to the extraction procedure. Median tumor circumferential diameter was 3.3 (range: 2.2 to 7.0) cm. Median follow-up duration was 17 (range: 8 to 27) months. There was no instance of sexual dysfunction. CONCLUSIONS Transvaginal NOSE for colorectal cancer surgery is feasible and safe in selected patients. Overall specimen diameter, inclusive of tumor and mesentery, relative to pelvic outlet and conduit diameter is the most important consideration for transvaginal NOSE.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Seow-En I, Lin W, Chen LR, Tan EKW. Three-port laparoscopic anterior resection for sigmoid cancer with transanal natural orifice specimen extraction (NOSE) and single-stapling colorectal anastomosis. Tech Coloproctol 2023; 27:695-696. [PMID: 36484933 DOI: 10.1007/s10151-022-02736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Affiliation(s)
- I Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore.
| | - W Lin
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - L R Chen
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - E K-W Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Zheng V, Wee IJY, Abdullah HR, Tan S, Tan EKW, Seow-En I. Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review. Int J Colorectal Dis 2023; 38:110. [PMID: 37121985 PMCID: PMC10149457 DOI: 10.1007/s00384-023-04408-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs are well-established, resulting in improved outcomes and shorter length of hospital stay (LOS). Same-day discharge (SDD), or "hyper-ERAS", is a natural progression of ERAS. This systematic review aims to compare the safety and efficacy of SDD against conventional ERAS in colorectal surgery. METHODS The protocol was prospectively registered in PROSPERO (394793). A systematic search was performed in major databases to identify relevant articles, and a narrative systematic review was performed. Primary outcomes were readmission rates and length of hospital stay (LOS). Secondary outcomes were operative time and blood loss, postoperative pain, morbidity, nausea or vomiting, and patient satisfaction. Risks of bias was assessed using the ROBINS-I tool. RESULTS Thirteen studies were included, with five single-arm and eight comparative studies, of which one was a randomised controlled trial. This comprised a total of 38,854 patients (SDD: 1622; ERAS: 37,232). Of the 1622 patients on the SDD pathway, 1590 patients (98%) were successfully discharged within 24 h of surgery. While most studies had an overall low risk of bias, there was considerable variability in inclusion criteria, types of surgery or anaesthesia, and discharge criteria. SDD resulted in a significantly reduced postoperative LOS, without increasing risk of 30-day readmission. Intraoperative blood loss and postoperative morbidity rates were comparable between both groups. Operative duration was shorter in the SDD group. Patient-reported satisfaction was high in the SDD cohort. CONCLUSION SDD protocols appear to be safe and feasible in selected patients undergoing major colorectal operations. Randomised controlled trials are necessary to further substantiate these findings.
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Affiliation(s)
- V Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - I J Y Wee
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - H R Abdullah
- Department of Anaesthesiology, Singapore General Hospital, Singapore City, Singapore
| | - S Tan
- Department of Anaesthesiology, Singapore General Hospital, Singapore City, Singapore
| | - E K W Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - I Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore.
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Seow-En I, Koh YX, Tan EKW. Transanal Natural Orifice Specimen Extraction Following Combined Laparoscopic Anterior Resection and Liver Resection. Dis Colon Rectum 2023; 66:e216-e217. [PMID: 36876979 DOI: 10.1097/dcr.0000000000002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Ye-Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
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8
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Zhu TY, Deng XM, Wang GJ, Wang JT, Li RX, Gao BL, Hu ZH. Thoracolaparoscopic radical resection of esophagogastric junction cancers with a NOSE-like approach to extract large specimens. Medicine (Baltimore) 2023; 102:e33120. [PMID: 36827022 DOI: 10.1097/md.0000000000033120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
To investigate the efficacy and safety of combined thoracoscopic and laparoscopic radical resection of esophagogastric junction cancers using a natural orifice specimen extraction-like approach for extraction of large surgical specimens. Patients who had esophagogastric junction cancers treated with thoracolaparoscopic resection using the natural orifice specimen extraction-like approach for specimen extraction were retrospectively enrolled. A 5-cm transverse incision on the abdominal wall at the middle of the superior pubic symphysis was made for surgical specimen extraction. The clinical, surgical, complications, and follow-up data were analyzed. A total of 162 patients were enrolled, and the surgery was successful in all patients (100%). The total surgical duration ranged 165 to 270 minutes, with blood loss 20 to 150 mL, hospital stay 8 to 22 days, first flatus time 2 to 7 days, extubation time of drainage tubes 1 to 26 days, first oral feeding time 5 to 10 days, number of lymph nodes resected 15 to 39, postoperative ambulation time 1 to 2 days, and postoperative residual rate of cancerous cells at the surgical margins 0. Postoperative complications occurred in 14 (8.6%), including anastomotic leakage in 4 (2.5%), anastomotic stenosis in 3 (1.9%), hydrothorax in 4 (2.5%), and incision infection in 3 (1.9%). At follow-up (mean 12 months), all patients were alive, and the transverse incision was a linear scar concealed in the suprapubic pubic hair area. The combined laparoscopic and thoracoscopic surgery for radical resection of carcinomas at the esophagogastric junction is safe and effective, and a transverse incision at the suprapubic symphysis for specimen extraction results in improved minimal invasiveness and cosmesis.
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Affiliation(s)
- Tian-Yu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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9
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Transvaginal Natural Orifice Specimen Extraction Following Laparoscopic Combined D3 Right Hemicolectomy and Liver Resection. Dis Colon Rectum 2022; 65:e1070-e1071. [PMID: 36382842 DOI: 10.1097/dcr.0000000000002440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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The Nuts and Bolts of Implementing a Modified ERAS Protocol for Minimally Invasive Colorectal Surgery: Group Practice vs. Solo Practice. J Clin Med 2022; 11:jcm11236992. [PMID: 36498566 PMCID: PMC9739177 DOI: 10.3390/jcm11236992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/13/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
AIM: The ERAS protocol consists of multiple items that aim to improve the outcomes of patients receiving surgery. Adhering to the protocol is difficult. We wondered whether surgeons practicing the ERAS protocol in a group would improve patient outcomes. Methods: All patients who underwent colorectal resection for benign disease or malignancy from November 2017 to December 2018 were collected and reviewed retrospectively. According to the physician’s ward round strategy, the patients were categorized into two groups, either by solo practice or group practice. Results: This study enrolled 724 patients and divided them into two groups according to the practice method: group practice (n = 256) and solo practice (n = 468). The group practice cohort had less postoperative morbidity (14.0% vs. 21.4%, p = 0.048) and shorter postoperative hospital stays (mean: 6.6 ± 3.2 vs. 8.6 ± 5.5, p < 0.05) than the solo practice cohort. Group practice (p < 0.001), natural orifice specimen extraction (NOSE) procedure (p < 0.001), and blood loss >50 mL (p = 0.039) significantly affected discharge within 5 days postoperatively in multivariate analyses. Conclusions: Group practice based on a modified ERAS protocol shortens postoperative hospital stays with fewer morbidities compared with solo practice in which patients receive elective minimally invasive colorectal surgery.
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Seow-En I, Khor SN, Tan KW. Laparoscopic 3-port anterior resection with transvaginal natural orifice specimen extraction (NOSE) in a patient with a high BMI: A video vignette. Colorectal Dis 2022; 24:1443-1444. [PMID: 35662379 DOI: 10.1111/codi.16213] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/03/2022] [Accepted: 05/29/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Shao Nan Khor
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
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12
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Muhammad S, Gao Y, Guan X, QingChao T, Fei S, Wang G, Chen Y, Liu Z, Jiang Z, Kaur K, Tatiana K, Ul Ain Q, Wang X, He J. Laparoscopic natural orifice specimen extraction, a minimally invasive surgical technique for mid-rectal cancers: Retrospective single-center analysis and single-surgeon experience of selected patients. J Int Med Res 2022; 50:3000605221134472. [PMID: 36440806 PMCID: PMC9712411 DOI: 10.1177/03000605221134472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 10/05/2022] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To evaluate the feasibility, safety, and short-term outcomes of middle rectal resection followed by transanal specimen extraction. METHODS Forty-four patients with small mid-rectal tumors underwent laparoscopic rectal resection followed by transanal specimen extraction. RESULTS The procedure was successful in all patients without intraoperative conversion or additional access. The mean operation time was 182.7 minutes (range, 130-255 minutes), the mean blood loss was 26.5 mL (range, 5-120 mL), the mean postoperative exhaust time was 31.3 hours (range, 16-60 hours), and the mean length of hospital stay was 9.5 days (range, 8-19 days). One patient developed anastomotic leakage, which was treated by intravenous antibiotics and daily pelvic cavity flushes through the abdominal drainage tube. No infection-related complications or anal incontinence were observed. The mean tumor size was 2.1 cm (range, 1.6-3.2 cm), the mean number of harvested lymph nodes was 16.5 (range, 6-31), and the mean follow-up time was 8.5 months (range, 2-16 months). By the last follow-up, no signs of recurrence had been found in any patient. CONCLUSION The combination of standard laparoscopic proctectomy and transanal specimen extraction could become a well-established strategy for selected patients.
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Affiliation(s)
- Shan Muhammad
- Department of Thoracic Surgery, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021, China
- Laboratory of Translational Medicine, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,
China
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - YiBo Gao
- Department of Thoracic Surgery, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021, China
- Laboratory of Translational Medicine, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,
China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
| | - Tang QingChao
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Shao Fei
- Department of Thoracic Surgery, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021, China
- Laboratory of Translational Medicine, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,
China
| | - Guiyu Wang
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Yinggang Chen
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
| | - Kavanjit Kaur
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | | | - Qurat Ul Ain
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences & Peking Union Medical College, Beijing 100021,
China
- Department of Colorectal Surgery, the Second Affiliated Hospital
of Harbin Medical University, Harbin 150086, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National
Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical
Sciences and Peking Union Medical College, Beijing 100021, China
- Laboratory of Translational Medicine, National Cancer
Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing 100021,
China
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13
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Hu ZH, Li RX, Wang JT, Wang GJ, Deng XM, Zhu TY, Gao BL, Zhang YF. Thoracolaparoscopic esophagectomy for esophageal cancer with a cervical or abdominal incision to extract specimen. Medicine (Baltimore) 2022; 101:e31131. [PMID: 36316905 PMCID: PMC9622648 DOI: 10.1097/md.0000000000031131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Surgery is the only curative approach for resectable esophageal cancer. This retrospective study was to investigate the immediate effect and operative complications of conventional and modified thoracolaparoscopic esophagectomy with a cervical or abdominal incision to extract specimen for the treatment of patients with esophageal cancer. Eighty-one patients were enrolled, among which 55 patients underwent conventional McKeown thoracolaparoscopic esophagectomy (conventional MTE) and 26 patients underwent modified MTE with a cerivical incision (modified MTE). The clinical, surgical, and postoperative data were analyzed. No significant (P > .05) difference was detected in the clinical data between two groups. The surgical procedure was successful in all patients (100%). The surgical time was significantly (P = .018) shorter in the conventional MTE group than in the modified MTE group (280 min vs 317 min). However, no significant (P > .05) difference was found in blood loss (200 mL vs 180 mL), intensive care unit (ICU) stay (31.3 ± 11.3 vs 25.2 ± 6.4 hours), first flatus after surgery (2.9 ± 1.9 vs 3.3 ± 1.6 days), postoperative hospital stay (12.9 ± 5.6 vs 12.6 ± 3.3 days), total number of lymph nodes dissected (27.9 ± 4.1 vs 26.7 ± 5.7), types of carcinoma, and pathological classification. No significant (P > .05) differences were detected in postoperative complications between the two groups. Assessment of postoperative pain using the visual analogue scale (VAS) score showed a significant (P < .05) difference in the VAS score at day 2 (4.81 ± 1.70 vs 3.87 ± 1.14) and day 3 (5.10 ± 0.83 vs 4.61 ± 1.12) between the conventional and modified MTE groups. The modified McKeown thoracolaparoscopic esophagectomy with only one cervical incision is more minimally invasive, more cosmetic, and less painful than the conventional approach.
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Affiliation(s)
- Zhi-Hao Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui-Xin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing-Tao Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guo-Jun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Guo-Jun Wang, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou 450052, China (e-mail: )
| | - Xiu-Mei Deng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tian-Yu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bu-Lang Gao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yun-Fei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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14
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Seow-En I, Chen LR, Li YX, Zhao Y, Chen JH, Abdullah HR, Tan EKW. Outcomes after natural orifice extraction vs conventional specimen extraction surgery for colorectal cancer: A propensity score-matched analysis. World J Clin Oncol 2022; 13:789-801. [PMID: 36337314 PMCID: PMC9630998 DOI: 10.5306/wjco.v13.i10.789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Natural orifice specimen extraction (NOSE) via the anus or vagina replaces conventional transabdominal specimen retrieval via the transabdominal route through a limited mid-line laparotomy or Pfannenstiel incision. Reducing the number of laparoscopic ports further decreases operative abdominal wall trauma. These techniques reduce the surgical wound size as well as the risk of incision-related morbidity.
AIM To compare short-term outcomes following 3-port NOSE surgery with a matched cohort of conventional non-NOSE colorectal cancer surgery.
METHODS Patients who underwent elective 3-port laparoscopic colorectal NOSE surgery between February to October 2021 were identified. Selection criteria for NOSE surgery was adapted from the 2019 International Consensus on Natural Orifice Specimen Extraction Surgery for colorectal cancer. Patients with clinical T4 or N2 tumors on staging computed tomography were also excluded. The propensity score-matched cohort was identified amongst patients who underwent conventional laparoscopic colorectal surgery from January 2019 to December 2020. Matching was performed in the ratio of 1:4 based on age, gender, type of resection, and p - tumor node metastasis staging.
RESULTS Over the eight-month study duration, 14 consecutive cases (nine female, five male) of elective 3-port laparoscopic surgery with NOSE were performed for colorectal cancer. Median age and body mass index were 70 (range 43-82) years and 24.1 (range 20.0-31.7) kg/m2 respectively. Six patients underwent transanal NOSE and eight had transvaginal NOSE. Median operative time, intraoperative blood loss and postoperative length of stay were 208 (range 165-365) min, 30 (range 10-150) mL and 3 (range 2-6) d respectively. Two (14%) suffered minor postoperative compilations not attributable to the NOSE procedure. Median follow-up duration was 12 (range 8-15) mo. No instances of mortality, local or distant disease recurrence were recorded in this cohort. Compared to the conventional surgery cohort of 56 patients, the 3-port NOSE cohort had significantly quicker mean return of bowel function (2.6 vs 1.2 d, P < 0.001), reduced postoperative pain and patient-controlled analgesia use, and decreased length of hospital stay (6.4 vs 3.4 d, P < 0.001). There were no statistical differences in surgical duration and perioperative complication rates between the NOSE and non-NOSE cohorts.
CONCLUSION 3-port laparoscopic colorectal surgery with NOSE is a feasible technique, augmenting the minimally invasive nature of surgery and producing good outcomes. Appropriate patient selection and expertise in conventional laparoscopy are required.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Lionel Raphael Chen
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yi-Xin Li
- Department of Surgery, Duke-NUS Graduate Medical School, Singapore 169857, Singapore
| | - Yun Zhao
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Jing-Hui Chen
- Department of Anaesthesiology, Singapore General Hospital, Singapore 169608, Singapore
| | - Hairil Rizal Abdullah
- Department of Anaesthesiology, Singapore General Hospital, Singapore 169608, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
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15
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Li Z, Xiong H, Qiao T, Jiao S, Zhu Y, Wang G, Wang X, Tang Q. Long-term oncologic outcomes of natural orifice specimen extraction surgery versus conventional laparoscopic-assisted resection in the treatment of rectal cancer: a propensity-score matching study. BMC Surg 2022; 22:286. [PMID: 35879754 PMCID: PMC9317461 DOI: 10.1186/s12893-022-01737-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Natural orifice specimen extraction surgery (NOSES) has been increasingly applied in radical surgery of abdominal and pelvic organs, but it is still in the exploratory stage. There is insufficient evidence to prove its efficacy. METHODS From January 2013 to June 2017, a total of 351 patients diagnosed with rectal cancer were eventually included in this study. Patients who underwent NOSES were assigned to the NOSES group, while patients undergoing conventional laparoscopic assisted resection were assigned as to the LAP group. Propensity score matching was used to align clinicopathological features between the two groups. RESULTS From the perioperative data and postoperative follow-up results of both groups, patients in the NOSES group had less intraoperative bleeding (47.0 ± 60.4 ml vs 87.1 ± 101.2 ml, P = 0.011), shorter postoperative gastrointestinal recovery (50.7 ± 27.3 h vs 58.6 ± 28.5 h, P = 0.040), less postoperative analgesic use (36.8% vs 52.8%, P = 0.019), lower postoperative pain scores (P < 0.001), lower rate of postoperative complications (5.7% vs 15.5%, P = 0.020), more satisfaction with body image (P = 0.001) and cosmesis (P < 0.001) postoperatively. The NOSES group had a higher quality of life. Moreover, there was no significant difference in overall survival (OS) and disease-free survival (DFS) between the two groups. CONCLUSION NOSES could be a safe and reliable technique for radical resection of rectal cancer, with better short-term outcomes than conventional laparoscopy, while long-term survival is not significantly different from that of conventional laparoscopic surgery.
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Affiliation(s)
- Zhengliang Li
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Huan Xiong
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Tianyu Qiao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Shuai Jiao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Yihao Zhu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Xishan Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China. .,Department 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, 100021, China.
| | - Qingchao Tang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China.
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16
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Seow-En I, Koo CH, Chen LR, Tan EKW. 3-port laparoscopic D3 right hemicolectomy with transvaginal natural orifice specimen extraction - A Video Vignette. Colorectal Dis 2022; 24:880-881. [PMID: 35258158 DOI: 10.1111/codi.16110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/19/2022] [Accepted: 02/27/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Chee Hoe Koo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Lionel Raphael Chen
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
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17
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Pedrazzani C, Conti C, Turri G, Gecchele G, Valdegamberi A, Guglielmi A. Video correspondence for laparoscopic anterior resection with natural orifice specimen extraction-a video vignette. Colorectal Dis 2022; 24:535-536. [PMID: 34990059 DOI: 10.1111/codi.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/23/2021] [Accepted: 12/30/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Corrado Pedrazzani
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Cristian Conti
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Giulia Turri
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Gabriele Gecchele
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Alessandro Valdegamberi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Alfredo Guglielmi
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy
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18
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Wang K, Li W, Liu N, Cai J, Zhang Y. Safety and oncological outcomes of natural orifice specimen extraction surgery compared with conventional laparoscopic surgery for right hemicolectomy: a systematic review and meta-analysis. Updates Surg 2022; 74:833-842. [PMID: 35304899 DOI: 10.1007/s13304-022-01276-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/06/2022] [Indexed: 11/29/2022]
Abstract
Natural orifice specimen extraction surgery (NOSES) is a new technique and uses natural orifice as the delivery route for specimen extraction to avoid supererogatory incision, and the safety and oncological outcomes of NOSES for right hemicolectomy are still inconclusive, so a meta-analysis was performed to compare these to conventional laparoscopic surgery (CLS). Related literature comparing NOSES with CLS for right hemicolectomy, whether randomized controlled trials (RCTs) or retrospective studies, were systematically searched. A random-effect model or fixed-effect model was used based on the I2 value. A total of six studies (all retrospective trials) involving 609 participants were included. Compared with CLS, NOSES was more preponderant than CLS in terms of surgical morbidity [odds ratio (OR) = 0.31; P = 0.0002], length of hospital stay [weighted mean difference (WMD) = - 1.52; P = 0.006], time to first flatus (WMD = - 0.82; P = 0.0008) and liquid intake (WMD = - 1.40; P < 0.00001), pain score of POD1 (WMD = - 1.99; P < 0.00001) and POD3 (WMD = - 1.15; P = 0.02), and cosmetic result (WMD = 1.84; P < 0.00001), while operative time of NOSES was prolonged (WMD = 18.29; P = 0.04). The number of dissected lymph nodes, recurrence, and 3-year overall survival (3-year OS) in NOSES group were comparable to the CLS group. Despite the lack of enough evidence, NOSES for right hemicolectomy has demonstrated comparable safety and oncological outcomes as CLS with less postoperative morbidity and pain, better cosmetic effect, and rapider recovery.
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Affiliation(s)
- Kang Wang
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China.,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China.,Medical College of Xiamen University, Xiamen, 361000, China
| | - Wenya Li
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China.,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China.,Medical College of Xiamen University, Xiamen, 361000, China
| | - Ningquan Liu
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China.,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China.,Medical College of Xiamen University, Xiamen, 361000, China
| | - Jianchun Cai
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China. .,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China. .,Medical College of Xiamen University, Xiamen, 361000, China.
| | - Yiyao Zhang
- Departments of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen, 361000, China. .,Gastrointestinal Oncology Center of Xiamen University, Xiamen, 361000, China. .,Medical College of Xiamen University, Xiamen, 361000, China.
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19
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Jong BK, Cheng CC, Hsu YJ, Chern YJ, Tsai WS, Hung HY, Liao CK, Yeh CY, Hsieh PS, You JF. Transrectal natural orifice specimen extraction in left hemicolectomy for tumours around the splenic flexure: Old wine in new bottles. Colorectal Dis 2022; 24:128-132. [PMID: 34601777 DOI: 10.1111/codi.15930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic anterior resection with natural orifice specimen extraction (NOSE) has favourable short-term outcomes. However, NOSE is rarely adopted for left hemicolectomy procedures. This study aimed to review the feasibility, safety and short-term outcomes of transrectal NOSE in patients undergoing laparoscopic left hemicolectomy. METHOD All consecutive patients who underwent laparoscopic left hemicolectomy surgery with transrectal NOSE in a single institution between January 2018 and December 2020 were reviewed. Transrectal NOSE was performed with an enterotomy at the upper rectum. The specimen was brought out via a transanal endoscopic microsurgery scope inserted through the anus. A supplementary video demonstrates this technique. Surgical outcomes, including complications, postoperative short-term recovery and the level of pain intensity, are presented. RESULTS Twenty patients were reviewed. There were no immediate postoperative complications and no wound infections in these patients. The average time to tolerate a soft diet was 3.6 days, and the average postoperative hospital stay was 4.5 days. The average score on the numerical rating scale of postoperative pain was 3.0 on postoperative day 1. The median follow-up time was 23.5 months. CONCLUSION Laparoscopic left hemicolectomy with transrectal NOSE is a safe and feasible procedure that leads to early postoperative recovery and a short hospital stay.
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Affiliation(s)
- Bor-Kang Jong
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chung Cheng
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jen Hsu
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Jong Chern
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Sy Tsai
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yuan Hung
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,New Taipei City Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chun-Kai Liao
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Yeh
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Shiu Hsieh
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jeng-Fu You
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
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20
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Brincat SD, Lauri J, Cini C. OUP accepted manuscript. BJS Open 2022; 6:6594734. [PMID: 35640267 PMCID: PMC9155237 DOI: 10.1093/bjsopen/zrac074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/14/2022] Open
Abstract
Background Natural orifice specimen extraction (NOSE) is a technique that involves collecting a specimen for extraction through a natural opening avoiding a mini-laparotomy incision. The aim of this study was to compare NOSE and transabdominal specimen extraction in laparoscopic (LAP) colorectal cancer surgery for postoperative outcomes and oncological safety. Method A systematic search was conducted in five electronic databases from inception till October 2020. Articles were selected based on the inclusion criteria (studies comparing LAP and NOSE colorectal surgeries reporting at least one of the outcomes) and analysed. Primary outcomes included postoperative complications, pathological results (resection margins and lymph node collection), and oncological outcomes. Secondary outcomes included operating time, blood losses, use of analgesics, functional recovery, duration of hospital stay, and cosmetic results. Fixed and random-effect models were used to measure the pooled estimates. Results Nineteen studies involving a total of 3432 participants were analysed (3 randomized clinical trials (RCTs) and 16 retrospective non-randomized studies). Pooled results showed significantly reduced postoperative complications (OR 0.54; 95 per cent c.i. 0.44 to 0.67; P < 0.00001). Pathological outcomes of NOSE were comparable to LAP with no significant difference noted in terms of resection margins (P > 0.05) and lymph node collection (weighted mean difference (WMD) −0.47; 95 per cent c.i. −0.94 to 0; P = 0.05). Pooled analysis demonstrated comparable long-term outcomes in terms of cancer recurrence (OR 0.94; 95 per cent c.i. 0.63 to 1.39; P = 0.75), 5-year disease-free survival (HR 0.97; 95 per cent c.i. 0.73 to 1.29; P = 0.83), and overall survival (HR 0.93, 95 per cent c.i. 0.58 to −1.51; P = 0.78). Finally, the NOSE group had decreased use of additional analgesia after surgery and earlier resumption of oral intake when compared with LAP (respectively OR 0.28; 95 per cent c.i. 0.20 to 0.37; P < 0.00001 and WMD −0.35; 95 per cent c.i. −0.54 to −0.15; P = 0.0005). Conclusion This meta-analysis showed that in comparison with LAP, NOSE decreases severe postoperative morbidity while improving postoperative recovery without compromising oncological safety, but it is limited by the small number of RCTs performed in this field.
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Affiliation(s)
- Svetlana Doris Brincat
- Correspondence to: Svetlana Doris Brincat, Department of Surgery, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, Malta (e-mail: )
| | - Josef Lauri
- Department of Mathematics and Statistics, University of Malta, Msida, Malta
| | - Charles Cini
- Department of Surgery, Mater Dei Hospital, Msida, Malta
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21
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Huang SF, Chu PT, Wang JH. A feasible technique for laparoscopic sigmoidectomy with natural orifice specimen extraction (NOSE)-a Video Vignette. Tech Coloproctol 2021; 26:151-152. [PMID: 34499278 DOI: 10.1007/s10151-021-02511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- S-F Huang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - P-T Chu
- Division of Colon and Rectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st RD, R.O.C., Kaohsiung, 81346, Taiwan
| | - J-H Wang
- Division of Colon and Rectal Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st RD, R.O.C., Kaohsiung, 81346, Taiwan.
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22
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The influence of diabetes on postoperative complications following colorectal surgery. Tech Coloproctol 2021; 25:267-278. [PMID: 33386511 PMCID: PMC7775741 DOI: 10.1007/s10151-020-02373-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/29/2020] [Indexed: 01/04/2023]
Abstract
Background Diabetes mellitus has been commonly associated with poor surgical outcomes. The aim of this meta-analysis was to assess the impact of diabetes on postoperative complications following colorectal surgery. Methods Medline, Embase and China National Knowledge Infrastructure electronic databases were reviewed from inception until May 9th 2020. Meta-analysis of proportions and comparative meta-analysis were conducted. Studies that involved patients with diabetes mellitus having colorectal surgery, with the inclusion of patients without a history of diabetes as a control, were selected. The outcomes measured were postoperative complications. Results Fifty-five studies with a total of 666,886 patients comprising 93,173 patients with diabetes and 573,713 patients without diabetes were included. Anastomotic leak (OR 2.407; 95% CI 1.837–3.155; p < 0.001), surgical site infections (OR 1.979; 95% CI 1.636–2.394; p < 0.001), urinary complications (OR 1.687; 95% CI 1.210–2.353; p = 0.002), and hospital readmissions (OR 1.406; 95% CI 1.349–1.466; p < 0.001) were found to be significantly higher amongst patients with diabetes following colorectal surgery. The incidence of septicemia, intra-abdominal infections, mechanical failure of wound healing comprising wound dehiscence and disruption, pulmonary complications, reoperation, and 30-day mortality were not significantly increased. Conclusions This meta-analysis and systematic review found a higher incidence of postoperative complications including anastomotic leaks and a higher re-admission rate. Risk profiling for diabetes prior to surgery and perioperative optimization for patients with diabetes is critical to improve surgical outcomes. Electronic supplementary material The online version of this article (10.1007/s10151-020-02373-9) contains supplementary material, which is available to authorized users.
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