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Chang JHE, Xu H, Zhao Y, Wee IJY, Ang JX, Tan EKW, Seow-En I. Transvaginal versus transabdominal specimen extraction in minimally invasive surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:172. [PMID: 38829526 PMCID: PMC11147895 DOI: 10.1007/s00423-024-03361-5] [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: 11/22/2023] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
AIM Natural orifice specimen extraction (NOSE) is an alternative to conventional transabdominal retrieval. We aimed to compare outcomes following transvaginal specimen extraction (TVSE) and transabdominal specimen extraction (TASE) in minimally invasive abdominal surgery. METHODS An electronic database search of PubMed, Embase and CENTRAL was performed from inception until March 2023. Comparative studies evaluating TVSE versus TASE in adult female patients were included. Studies involving transanal NOSE, endoluminal surgery, or TVSE with concomitant hysterectomy were excluded. Weighted mean differences (WMD) and odds ratio were estimated for continuous and dichotomous outcomes respectively. Primary outcomes were postoperative day 1 (POD1) pain and length of stay (LOS). Secondary outcomes were operative time, rescue analgesia, morbidity, and cosmesis. A review of sexual, oncological, and technical outcomes was performed. RESULTS Thirteen studies (2 randomised trials, 11 retrospective cohort studies), involving 1094 patients (TASE 583, TVSE 511), were included in the analysis. Seven studies involved colorectal disease and six assessed gynaecological conditions. TVSE resulted in significantly decreased POD1 pain (WMD 1.08, 95% CI: 0.49, 1.68) and shorter LOS (WMD 1.18 days, 95% CI: 0.14, 2.22), compared to TASE. Operative time was similar between both groups, with fewer patients requiring postoperative rescue analgesia with TVSE. Overall morbidity rates, as well as both wound-related and non-wound related complication rates were better with TVSE, while anastomotic morbidity rates were comparable. Cosmetic scores were higher with TVSE. TVSE did not result in worse sexual or oncological outcomes. CONCLUSION TVSE may be feasible and beneficial compared to TASE when performed by proficient laparoscopic operators, using appropriate selection criteria. Continued evaluation with prospective studies is warranted.
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Affiliation(s)
- Jasmine Hui Er Chang
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Hongyun Xu
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Yun Zhao
- Group Finance Analytics, Singapore Health Services, Singapore, Singapore
| | - Ian Jun Yan Wee
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Joella Xiaohong Ang
- Department of Obstetrics & Gynaecology, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Outram Road, 169608, Singapore.
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Muhammad S, Jiang Z, Fan T, Tang Q, Hai Y, Ehsan SBE, Bilal M, Zubayraeva AA, Gao Y, He J. Advancing mid-rectal cancer surgery: Unveiling the potential of natural orifice specimen extraction surgery in comparison to conventional laparoscopic-assisted resection. Cancer Rep (Hoboken) 2024; 7:e2003. [PMID: 38703000 PMCID: PMC11069103 DOI: 10.1002/cnr2.2003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Mid-rectal cancer treatment traditionally involves conventional laparoscopic-assisted resection (CLAR). This study aimed to assess the clinical and therapeutic advantages of Natural Orifice Specimen Extraction Surgery (NOSES) over CLAR. AIMS To compare the clinical outcomes, intraoperative metrics, postoperative recovery, complications, and long-term prognosis between NOSES and CLAR groups. MATERIALS & METHODS A total of 136 patients were analyzed, with 92 undergoing CLAR and 44 undergoing NOSES. Clinical outcomes were evaluated, and propensity score matching (PSM) was employed to control potential biases. RESULTS The NOSES group exhibited significant improvements in postoperative recovery, including lower pain scores on days 1, 3, and 5 (p < .001), reduced need for additional analgesics (p = .02), shorter hospital stays (10.8 ± 2.3 vs. 14.2 ± 5.3 days; p < .001), and decreased intraoperative blood loss (48.1 ± 52.7 mL vs. 71.0 ± 55.0 mL; p = .03). Patients undergoing NOSES also reported enhanced satisfaction with postoperative abdominal appearance and better quality of life. Additionally, the NOSES approach resulted in fewer postoperative complications. CONCLUSION While long-term outcomes (overall survival, disease-free survival, and local recurrence rates) were comparable between the two methods, NOSES demonstrated superior postoperative outcomes compared to CLAR in mid-rectal cancer treatment, while maintaining similar long-term oncological safety. These findings suggest that NOSES could serve as an effective alternative to CLAR without compromising long-term results.
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Affiliation(s)
- Shan Muhammad
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Department of Colorectal SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
- Department of Colorectal SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zheng Jiang
- Department of Colorectal SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Tao Fan
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - QingChao Tang
- Department of Colorectal SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Yang Hai
- Department of Children's and Adolescent HealthPublic Health College of Harbin Medical UniversityHarbinChina
| | - Sundas Bint E. Ehsan
- Department of Colorectal SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Maimoona Bilal
- Department of General SurgerySecond Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Albina A. Zubayraeva
- Department of General SurgeryI.M. Sechenov Affiliated Hospital of I.M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - YiBo Gao
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jie He
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Laboratory of Translational Medicine, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Zheng Z, Kang F, Yang Y, Fang Y, Yao K, Zeng Q, Fu M, Luo L, Xue X, Lin S, Shi X, Fang X, Zhou B, Guo Y. Short-term clinical outcomes and five-year survival analysis of laparoscopic-assisted transanal natural orifice specimen extraction versus conventional laparoscopic surgery for sigmoid and rectal cancer: a single-center retrospective study. Front Surg 2024; 10:1340869. [PMID: 38234452 PMCID: PMC10791885 DOI: 10.3389/fsurg.2023.1340869] [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: 11/19/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024] Open
Abstract
Background The cosmetic benefits of natural orifice specimen extraction (NOSE) are easily noticeable, but its principles of aseptic and tumor-free procedure have caused controversy. Methods We conducted a retrospective analysis of the clinical data of patients who underwent laparoscopic-assisted transanal NOSE or conventional laparoscopic surgery (CLS) for sigmoid and rectal cancer at our hospital between January 2018 and December 2018. The study aimed to compare the general characteristics, perioperative indicators, postoperative complications, and five-year follow-up results between the two groups. Results A total of 121 eligible patients were enrolled, with 52 underwent laparoscopic-assisted transanal NOSE and 69 underwent CLS. There were no significant differences observed between the two groups in terms of gender, age, body mass index (BMI), TNM stage, etc. (P > 0.05). However, the NOSE group exhibited significantly shorter total incision length and longer operation time compared to the CLS group (P < 0.05). There were no statistically significant differences observed between the two groups in terms of positive rate of bacterial culture, incidence rates of intraabdominal infections or anastomotic leakage (P > 0.05). Furthermore, during follow-up period there was no statistically significant difference observed between these two groups concerning overall survival rate and disease-free survival outcomes (P > 0.05). Conclusions The management of surgical complications in CLS is exemplary, with NOSE presenting a sole advantage in terms of incision length albeit at the cost of prolonged operative time. Therefore, NOSE may be deemed appropriate for patients who place high emphasis on postoperative cosmetic outcomes.
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Affiliation(s)
- Zhizhong Zheng
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Fenfen Kang
- Department of Anesthesiology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Yugang Yang
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Yicong Fang
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Kaiyuan Yao
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Qunzhang Zeng
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Muhai Fu
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Lixiong Luo
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Xiajuan Xue
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Shuijie Lin
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Xingpeng Shi
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Xun Fang
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Baohua Zhou
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Yincong Guo
- Department of Colorectal and Anal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
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Li Z, Zhang X, Tian L, Liu Z, Liao X, Qiu J, Wang G, Yan L, Wang X, Wang X, Liu R. Case Report: Transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy for gastric cancer in a patient with situs inversus totalis: with video. Front Oncol 2023; 13:1189948. [PMID: 37287912 PMCID: PMC10242047 DOI: 10.3389/fonc.2023.1189948] [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: 03/28/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023] Open
Abstract
Because of its significant advantage of fast postoperative recovery, natural orifice specimen extraction surgery (NOSES) has attracted increasing attention worldwide. However, the NOSES in gastric cancer (GC) treatment still needs more clinical practice, especially for the rare anatomical anomaly. Situs inversus totalis (SIT) is a rare autosomal recessive anatomical anomaly with an incidence ranging between 1/8,000 and 1/25,000 births. We present a video of transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy performed in a 59-year-old woman known to have SIT. Preoperative investigations revealed that the patient had early GC at the antrum. A gastroscopy report from the local hospital showed signet-ring cell carcinoma. The preoperative computed tomography scan revealed irregular thickening of the gastric wall at the junction of the greater curvature and antrum without metastasis to the lymph nodes. In total, laparoscopic D2 distal gastrectomy was performed with transvaginal specimen extraction. Billroth II with Braun anastomosis was performed for reconstruction. The length of the operation was 240 min without intraoperative complications and with minimal blood loss of 50 ml. The patient was uneventfully discharged on postoperative Day 7. The final pathology confirmed signet-ring cell carcinoma confined to the mucosal muscle without metastasis in 16 lymph nodes. Transvaginal specimen extraction following totally laparoscopic D2 distal gastrectomy can be safely performed in patients with SIT and has similar surgical outcomes to usual laparoscopic gastrectomy.
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Affiliation(s)
- Zeyu Li
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiaolong Zhang
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Lifei Tian
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Zheng Liu
- 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, Beijing, China
| | - Xinhua Liao
- Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jian Qiu
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Guorong Wang
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Likun Yan
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiaoqiang Wang
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xishan Wang
- 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, Beijing, China
| | - Ruiting Liu
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
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Yu H, Lu W, Zhong C, Ju H, Wu C, Xu H, Liu D, Li T. Transvaginal versus transabdominal specimen extraction surgery for right colon cancer: A propensity matching study. Front Oncol 2023; 13:1168961. [PMID: 37091155 PMCID: PMC10117755 DOI: 10.3389/fonc.2023.1168961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundThe transvaginal route for specimen extraction is considered ideal for colorectal surgery, but its safety is still questioned. There has been little research on transvaginal natural orifice specimen extraction surgery (NOSES) in the right hemicolectomy. As a result, we conducted a study comparing transvaginal NOSES to traditional transabdominal specimen extraction surgery.Patients and methodsData on female patients who underwent radical right hemicolectomy at the First Affiliated Hospital of Nanchang University between January 2015 and December 2020 were collected retrospectively. A total of 847 patients were compliant, with 51 undergoing the transvaginal specimen extraction surgery (NOSES) group and 796 undergoing the transabdominal specimen extraction surgery (TISES) group. A propensity score matching method (1:2) was used to balance the clinicopathological characteristics of the two groups.ResultsFinally, 138 patients were enrolled in our study, with 46 in the NOSES group and 92 in the TISES group. Compared to the TISES group, the NOSES group had less intraoperative blood loss (p = 0.036), shorter time to first flatus (p < 0.001), shorter time to first liquid diet (p < 0.001), lower postoperative white blood cell counts (p = 0.026), lower C-reactive protein levels (p = 0.027), and lower visual analog scale (VAS) scores (p < 0.001). Regarding the quality of life after surgery, the NOSES group had better role function (p < 0.01), emotional function (p < 0.001), and improved symptoms of postoperative pain (p < 0.001) and diarrhea (p = 0.024). The scar satisfaction was significantly higher in the NOSES group than in the TISES group. Overall survival and disease-free survival in two groups were similar.ConclusionThe short-term results of transvaginal NOSES were superior to conventional transabdominal specimen extraction surgery. At the same time, transvaginal NOSES could improve the abdominal wall appearance and quality of life. The long-term survival was similar in the two surgical approaches. Therefore, transvaginal NOSES is worthy of our implementation and promotion.
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Affiliation(s)
| | | | | | | | | | | | | | - Taiyuan Li
- *Correspondence: Taiyuan Li, ; Dongning Liu,
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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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Lv J, Guan X, Wei R, Yin Y, Liu E, Zhao Z, Chen H, Liu Z, Jiang Z, Wang X. Development of artificial blood loss and duration of excision score to evaluate surgical difficulty of total laparoscopic anterior resection in rectal cancer. Front Oncol 2023; 13:1067414. [PMID: 36959789 PMCID: PMC10028132 DOI: 10.3389/fonc.2023.1067414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/03/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose Total laparoscopic anterior resection (tLAR) has been gradually applied in the treatment of rectal cancer (RC). This study aims to develop a scoring system to predict the surgical difficulty of tLAR. Methods RC patients treated with tLAR were collected. The blood loss and duration of excision (BLADE) scoring system was built to assess the surgical difficulty by using restricted cubic spline regression. Multivariate logistic regression was used to evaluate the effect of the BLADE score on postoperative complications. The random forest (RF) algorithm was used to establish a preoperative predictive model for the BLADE score. Results A total of 1,994 RC patients were randomly selected for the training set and the test set, and 325 RC patients were identified as the external validation set. The BLADE score, which was built based on the thresholds of blood loss (60 ml) and duration of surgical excision (165 min), was the most important risk factor for postoperative complications. The areas under the curve of the predictive RF model were 0.786 in the training set, 0.640 in the test set, and 0.665 in the external validation set. Conclusion This preoperative predictive model for the BLADE score presents clinical feasibility and reliability in identifying the candidates to receive tLAR and in making surgical plans for RC patients.
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Zhang ZC, Luo QF, Wang WS, Chen JH, Wang CY, Ma D. Development and future perspectives of natural orifice specimen extraction surgery for gastric cancer. World J Gastrointest Surg 2022; 14:1198-1203. [PMID: 36504515 PMCID: PMC9727573 DOI: 10.4240/wjgs.v14.i11.1198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/30/2022] [Accepted: 10/18/2022] [Indexed: 02/07/2023] Open
Abstract
In recent years, natural orifice specimen extraction surgery (NOSES), a novel minimally invasive surgical technique, has become a focus in the surgical field, and has been initially applied in gastric surgery in many national medical centers worldwide. In addition, this new surgical technique was launched in major hospitals in China. With an increasing number of patients who have accepted this new surgical technique, NOSES has provided new prospects for the treatment of gastric cancer (GC), which may achieve a better outcome for both patients and surgeons. More and more experts and scholars from different countries and regions are currently paying close attention to NOSES for the treatment of GC. However, there are only a few reports of its use in GC. This review focuses on the research progress in NOSES for radical gastrectomy in recent years. We also discuss the challenges and prospects of NOSES in clinical practice.
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Affiliation(s)
- Zhi-Cao Zhang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Qi-Fa Luo
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Wen-Sheng Wang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Jiang-Hong Chen
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Chen-Yu Wang
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
| | - Dan Ma
- Department of General Surgery, Xinqiao Hospital of Army Medical University, Chongqing 400037, China
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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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Hu K, Ke Y, Chen Q, Wu J, Ke Y, Xie Q, Liu B, Chen J. Case report: dual primary malignancies treated by laparoscopic multiorgan resection with natural orifice specimen extraction surgery. Front Oncol 2022; 12:916104. [PMID: 35965528 PMCID: PMC9372278 DOI: 10.3389/fonc.2022.916104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
With microtrauma becoming a consensus, in order to improve surgical treatment capability, the clinical application of laparoscopic multiorgan resection is becoming more and more complicated and diversified. Recently, we successfully presented a case of transvaginal specimen extraction surgery that included laparoscopic anatomical left hemihepatectomy combined with laparoscopic total hysterectomy and bilateral adnexectomy and the pelvic and para-aortic lymphadenectomy. The patient, a 75-year-old woman, was hospitalized with abnormal vaginal discharge and bleeding. The pathologic diagnosis of uterine curettage was endometrioid adenocarcinoma. After completing examinations such as color Doppler ultrasound, CEUS, MRCP and thoracoabdominal enhanced spiral CT, preoperative diagnosis was considered as endometrial cancer and a space-occupying lesion in the liver (primary or secondary site)?. No lymphatic or distant metastasis had been found. We also excluded Lynch syndrome by digestive endoscopy and gene sequencing. After a multidisciplinary consultation, the patient underwent surgery under general anesthesia on 24 September 2021. The operation was completed uneventfully in 6 hours, then the patient was transferred to the ICU for follow-up monitoring. The patient began to eat and was able to leave bed on the 4th postoperative day. According to immunohistochemistry, the patient's postoperative diagnosis was intrahepatic cholangiocarcinoma (ICC) and endometrial cancer. Compared with open surgery, laparoscopic multiorgan resection with natural orifice specimen extraction surgery (NOSES) has many advantages such as fewer traumas, shorter recovery time, and better postoperative quality of life. However, combined large-scale laparoscopic surgeries of different organs can be challenging for surgeons and anesthesiologists. No similar cases have been searched.
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Affiliation(s)
- Kunpeng Hu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China
| | - Yifan Ke
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qin Chen
- Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China
| | - Jiezhong Wu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yingping Ke
- Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China
| | - Qiuxian Xie
- Department of Gynecology, Chaozhou Central Hospital, Chaozhou, China
| | - Bo Liu
- Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiajia Chen
- Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China
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11
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Comparison of Natural Orifice Versus Transabdominal Specimen Extraction Following Laparoscopic Minor Hepatectomy. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02855-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Laparoscopic Natural Orifice Specimen Extraction Surgery versus Conventional Surgery in Colorectal Cancer: A Meta-Analysis of Randomized Controlled Trials. Gastroenterol Res Pract 2022; 2022:6661651. [PMID: 35087585 PMCID: PMC8789476 DOI: 10.1155/2022/6661651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/13/2021] [Indexed: 01/01/2023] Open
Abstract
Objective This study was to quantitatively synthesize data in randomized controlled trials (RCTs) of laparoscopic resection comparing natural orifice specimen extraction (NOSE) versus conventional laparoscopy (CL) in colorectal cancer. Methods We identified eligible RCTs by searching seven electronic databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, CQVIP, Wanfang, and Sinomed). Mean differences (MDs) between groups with 95% confidence intervals (CIs) were used for continuous outcomes. Event rate ratios (RRs) were also calculated with their 95% CIs. Results 1,569 citations were identified from electronic database as of June 2020, and finally, 21 RCTs involving 2,112 patients met the study eligibility criteria and were included. Compared to the CL group, NOSE had longer operation time (MD: 8.14 min, 95% CI: 3.02 to 13.25, and p < 0.01), less estimated blood loss (-10.64 ml, 95% CI: -14.92 to -6.36, and p < 0.01), less hospital stay after surgery (-2.21 days, 95% CI: -3.36 to -1.06, and p < 0.01), shorter time of gas passage after surgery (-0.58 days, 95% CI: -0.82 to -0.34, and p < 0.01), better pain score (-1.06, 95% CI: -3.74 to -0.37, and p < 0.01), and improved cosmetic scores (1.93, 95% CI: 0.77 to 3.10, p < 0.01). Rate ratios of total complications, infection, and incision infection all favored NOSE surgery, with RRs (95% CIs) of 0.81 (0.71 to 0.93), 0.34 (0.21 to 0.54), and 0.24 (0.12 to 0.51), respectively. Conclusion This report appeared the first comprehensive meta-analysis of RCTs to synthesize data of laparoscopic resection with NOSE versus conventional laparoscopy. NOSE surgery seemed favorable with shorter hospital stay, less pain score, a shorter time to recover along with better cosmetic scores, and less postoperative complications.
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Xu SZ, Cai JC. Laparoscopic-Assisted Natural Orifice Specimen Extraction Gastrectomy Using an Auxiliary Incision-free Tube for Gastric Cancer. J Surg Res 2021; 270:31-38. [PMID: 34628161 DOI: 10.1016/j.jss.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/21/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) gastrectomy effectively avoids the need for an abdominal incision, unlike conventional laparoscopic gastrectomy. In this study, we documented our experience with LA-NOSE gastrectomy using an auxiliary incision-free tube (Cai tube, a homemade invention: ZL201410168748.2) in 9 gastric cancer patients and summarized the clinical results. METHODS From July 2018 to June 2020, a total of 9 patients with gastric cancer were recruited for this study. LA-NOSE gastrectomy (subtotal or total) using the auxiliary incision-free tube and D2 lymph node dissection were performed. Specimens were extracted through the anterior wall of the upper rectum in 4 male patients and the posterior fornix of the vagina in 5 female patients using the auxiliary incision-free tube. RESULTS All 9 patients underwent successful laparoscopic gastrectomy with NOSE using the auxiliary incision-free tube. No perioperative death, re-admission within 60 days post operation, natural orifice wound infection or tumor implantation was observed. The mean operating time was 365.3±41.7 min, and the mean estimated blood loss was 87.8±39.3 ml. The mean duration of hospital stay was 11.3±1.2 days, while the mean maximum pain score (visual analogue score, VAS) was 2.3±0.9 on postoperative day (POD) 1, and the mean time to ambulation was 1.3±0.5 days. The 60-day postoperative morbidity rate was 11.1% (1/9). After a mean follow-up of 14.7±9.6 months, there was no transrectal or transvaginal access-site recurrence, no anterior rectectomy or posterior fornix colpotomy-related complications, and no local recurrence or distant metastasis. CONCLUSIONS Our preliminary experience indicates that this new technique, LA-NOSE gastrectomy using the auxiliary incision-free tube, is feasible for selected patients with gastric cancer.
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Affiliation(s)
- Shu-Zhen Xu
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen Fujian, China; Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, Fujian, China; Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, China.
| | - Jian-Chun Cai
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen Fujian, China; Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, Fujian, China; Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, China.
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14
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Meng H, Liu J, Xu H, Wang S, Rong Y, Xu Y, Yu G. Proctotomy leak following laparoscopic total gastrectomy with transrectal specimen extraction for gastric cancer: a case report. BMC Surg 2021; 21:218. [PMID: 33906630 PMCID: PMC8077703 DOI: 10.1186/s12893-021-01217-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite increasing acceptance in colorectal surgery, natural orifice specimen extraction (NOSE) surgery for the treatment of gastric cancer is still in its infancy, especially via the transrectal approach, which was barely reported. So little is known about its complications. Here we report the first case of proctotomy leak after transrectal NOSE gastrectomy, and our experience in preventive interventions. CASE PRESENTATION A 62-year-old male patient complaining of upper abdominal pain who underwent open distal gastrectomy for gastric cancer one year ago was diagnosed with recurrent gastric cancer by gastroscopic biopsy. We performed laparoscopic total gastrectomy with transrectal specimen extraction on the patient. The operation was completed in a total laparoscopic approach and the specimen was extracted through a 3 cm longitudinal incision in the anterior wall of the upper rectum, then interrupted sutures were used for full-thickness closure of the rectal incision. The operative time was 470 min and intra-operative blood loss was 100 mL. The postoperative pathological examination showed pT1bN0M0 gastric adenocarcinoma. The patient developed proctotomy leak on the 10th postoperative day. We analyzed the causes of this rare complication and put forward a series of technical improvements. After failure of conservative treatment, a diverting ileostomy was created and the patient eventually recovered. We successfully prevented proctotomy leak in the subsequent 20 transrectal NOSE gastrectomies using improved techniques. CONCLUSIONS Proctotomy leak after transrectal specimen extraction should be considered among the complications of NOSE surgery and can be prevented by technical precautions.
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Affiliation(s)
- Haipeng Meng
- Department of General Surgery, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, 758 Hefei Road, 266035, Qingdao, Shandong, China
| | - Jinchao Liu
- Department of Gastrointestinal Surgery, Zibo Municipal Hospital, 255400, Zibo, Shandong, China
| | - Hui Xu
- Department of Anesthesiology, Zibo Municipal Hospital, 255400, Zibo, Shandong, China
| | - Song Wang
- Department of Gastrointestinal Surgery, Zibo Municipal Hospital, 255400, Zibo, Shandong, China
| | - Yu Rong
- Department of Gastrointestinal Surgery, Zibo Municipal Hospital, 255400, Zibo, Shandong, China
| | - Yanling Xu
- Department of Respiratory Medicine, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, 758 Hefei Road, 266035, Qingdao, Shandong, China
| | - Gang Yu
- Department of General Surgery, Cheeloo College of Medicine, Qilu Hospital (Qingdao), Shandong University, 758 Hefei Road, 266035, Qingdao, Shandong, China. .,Department of Gastrointestinal Surgery, Zibo Municipal Hospital, 255400, Zibo, Shandong, China.
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Tang Q, Zhu Y, Xiong H, Sheng X, Hu Z, Hu H, Huang R, Zhang Q, Yuan Z, Xie L, Gao Z, Wang Y, Wang G, Wang X. Natural Orifice Specimen Extraction Surgery versus Conventional Laparoscopic-Assisted Resection in the Treatment of Colorectal Cancer: A Propensity-Score Matching Study. Cancer Manag Res 2021; 13:2247-2257. [PMID: 33727861 PMCID: PMC7955728 DOI: 10.2147/cmar.s291085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/20/2021] [Indexed: 12/16/2022] Open
Abstract
Background 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.
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Affiliation(s)
- Qingchao Tang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Yihao Zhu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Huan Xiong
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xiangzong Sheng
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Zhiqiao Hu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Hanqing Hu
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Rui Huang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Qian Zhang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Ziming Yuan
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Lei Xie
- Heilongjiang Agricultural Reclamation General Hospital, Harbin, People's Republic of China
| | - Zhifeng Gao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Yuliuming Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Guiyu Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xishan Wang
- 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, Beijing, People's Republic of China
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Chen J, Zhang Z, Chang W, Yi T, Feng Q, Zhu D, He G, Wei Y. Short-Term and Long-Term Outcomes in Mid and Low Rectal Cancer With Robotic Surgery. Front Oncol 2021; 11:603073. [PMID: 33767981 PMCID: PMC7985529 DOI: 10.3389/fonc.2021.603073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 01/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the risk factors for postoperative complications and anastomotic leakage after robotic surgery for mid and low rectal cancer and their influence on long-term outcomes. Methods A total of 641 patients who underwent radical mid and low rectal cancer robotic surgery at Zhongshan Hospital Fudan University from January 2014 to December 2018 were enrolled in this study. The clinicopathological factors of the patients were collected. The risk factors for short-term outcomes of complications and anastomotic leakage were analyzed, and their influences on recurrence and overall survival were studied. Results Of the 641 patients, 516 (80.5%) underwent AR or LAR procedures, while 125 (19.5%) underwent the NOSES procedure. Only fifteen (2.3%) patients had stoma diversion. One hundred and seventeen patients (17.6%) experienced surgical complications. Anastomotic leakage occurred in 44 patients (6.9%). Eleven patients (1.7%) underwent reoperation within 90 days after surgery. Preoperative radiotherapy did not significantly increase anastomotic leakage in our study (7.4% vs. 6.8%, P = 0.869). The mean postoperative hospital stay was much longer with complication (10.4 vs. 7.1 days, P<0.05) and leakage (12.9 vs. 7.4 days, P < 0.05). Multivariate analysis showed that male sex (OR = 1.855, 95% CI: 1.175–2.923, P < 0.05), tumor distance 5 cm from the anus (OR = 1.563, 95% CI: 1.016–2.404, P < 0.05), and operation time length (OR = 1.563, 95% CI: 1.009–2.421, P < 0.05) were independent risk factors for complications in mid and low rectal cancer patients. The same results for anastomotic leakage: male sex (OR = 2.247, 95% CI: 1.126–4.902, P < 0.05), tumor distance 5 cm from the anus (OR = 2.242, 95% CI: 1.197–4.202, P < 0.05), and operation time length (OR = 2.114, 95% CI: 1.127–3.968, P < 0.05). The 3-year DFS and OS were 82.4% and 92.6% with complication, 88.4% and 94.0% without complication, 88.6% and 93.1% with leakage, and 87.0% and 93.8% without leakage, respectively. The complication and anastomotic leakage showed no significant influences on long-term outcomes. Conclusion Being male, having a lower tumor location, and having a prolonged operation time were independent risk factors for complications and anastomotic leakage in mid and low rectal cancer. Complications and anastomotic leakage might have no long-term impact on oncological outcomes for mid and low rectal cancer with robotic surgery.
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Affiliation(s)
- Jingwen Chen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiyuan Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenju Chang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tuo Yi
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qingyang Feng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dexiang Zhu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guodong He
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ye Wei
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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