Laparoscopic D3 oncological resection in splenic flexure cancer: Technical details and its impact on long-term survival

Evaluation of the efficacy of natural orifice specimen extraction surgery versus conventional laparoscopic surgery for colorectal cancers: A systematic review and meta‐analysis

Aim

Natural orifice specimen extraction surgery (NOSES) has gained significant importance in treating cancers. The current study is a meta‐analysis that aimed to assess the short‐term efficacy and long‐term prognostic impact of NOSES and conventional laparoscopic (CL) surgery in the treatment of colorectal cancer (CRC).

Method

Published reports in several medical databases up to February 2024 were searched and information pertinent to outcomes of NOSES and CL in retrospective and randomized studies to treat CRC was collected. Pooled weighted/standardized mean difference (WMD/SMD), odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated using a fixed‐effects model or random‐effects model, and meta‐analysis was subsequently performed using Stata.

Results

Thirty‐one studies with a total of 4637 patients were included in this meta‐analysis. When compared with CL, NOSES had significant advantages in several indicators, such as wound infection [OR = 0.22 (95% CI 0.13–0.38); Z = 5.56, p = 0], incisional hernia [OR = 0.24 (95% CI 0.11–0.54); Z = 3.44, p = 0.001], blood loss [WMD = −10.17 (95% CI −14.75 to −5.60); Z = 4.36, p = 0], incision length [WMD = −4.94 (95% CI −5.27 to −4.60); Z = 29.10, p = 0.00], postoperative pain [WMD = −1.43 (95% CI −1.69 to −1.18); Z = 11.02, p = 0.00], use of additional analgesics [OR = 0.57 (95% CI 0.39–0.82); Z = 3.06, p = 0.002], hospital stay [WMD = –1.25 (95% CI −1.58 to –0.93); Z = 7.65, p = 0.00], gastrointestinal recovery [WMD = −13.42 (95% CI −17.77 to −9.07); Z = 6.05, p = 0.00], first flatus [WMD = −0.50 (95% CI −0.68 to −0.32); Z = 5.34, p = 0.00] and cosmetic result [WMD = 2.11 (95% CI 0.92–3.30); Z = 3.47, p = 0.001]. However, NOSES required a significantly longer duration of surgery [WMD = 14.13 (95% CI 6.70–21.56); Z = 3.73, p = 0.00]. There were no significant differences in postoperative anastomotic leakage, intra‐abdominal infection, lymph node harvest, proximal and distal margins, 5‐year disease‐free and 5‐year overall survival and pelvic floor function.

Conclusion

NOSES is considered an efficient surgical method of treatment for CRC that allows patients to have long‐term favourable oncological outcomes while recovering faster with minimal pain. However, these findings still require confirmation through studies on large population cohorts.

Tata Memorial Centre Evidence Based Management of Colorectal cancer

This review article examines the evidence-based management of colorectal cancers, focusing on topics characterized by ongoing debates and evolving evidence. To contribute to the scientific discourse, we intentionally exclude subjects with established guidelines, concentrating instead on areas where the current understanding is dynamic. Our analysis encompasses a thorough exploration of critical themes, including the evidence surrounding complete mesocolic excision and D3 lymphadenectomy in colon cancers. Additionally, we delve into the evolving landscape of perioperative chemotherapy in both colon and rectal cancers, considering its nuanced role in the context of contemporary treatment strategies. Advancements in surgical techniques are a pivotal aspect of our discussion, with an emphasis on the utilization of minimally invasive approaches such as laparoscopy and robotic surgery in both colon and rectal cancers, including advanced rectal cases. Moving beyond conventional radical procedures, we scrutinize the feasibility and implications of endoscopic resections for small tumors, explore the paradigm of organ preservation in locally advanced rectal cancers, and assess the utility of total neoadjuvant therapy in the current treatment landscape. Our final segment reviews pivotal trials that have significantly influenced the management of colorectal liver and peritoneal metastasis.