Transvaginal versus transabdominal specimen extraction surgery for right colon cancer: A propensity matching study

Natural Orifice Specimen Extraction for Right-Sided Colon Cancer: A Systematic Review and Meta-Analysis of Propensity Score-Matched Studies

Minimally invasive surgery is the standard approach for right-sided colon cancer, but conventional laparoscopic specimen extraction (CVT) requires additional abdominal incisions, increasing the risk of postoperative complications and delayed recovery. Natural orifice specimen extraction (NOSE) minimizes abdominal incisions, potentially improving patient outcomes. This meta-analysis compares NOSE and CVT in terms of postoperative complications, operative characteristics, and long-term outcomes. A comprehensive literature search was conducted in PubMed, Scopus, the Cochrane Central Register of Clinical Trials, and Web of Science for studies available up to December 2024. A random-effects model was applied to compute ORs and mean differences (MDs) with 95% CIs. Heterogeneity was evaluated using the I² statistic. All statistical analyses were performed using R software (version 4.4.1, R Foundation for Statistical Computing). Seven propensity score-matched studies with 566 patients were included, with 240 (42.4%) undergoing NOSE and 326 (57.6%) undergoing CVT. NOSE was associated with significantly reduced postoperative pain on the 3rd day (MD -1.1; 95% CI -1.7 to -0.5; p < 0.01), lower SSI rates (OR 0.23; 95% CI 0.08-0.73; p = 0.012), and a shorter time to pass flatus (MD -0.8; 95% CI -1.2 to -0.4; p < 0.01). However, NOSE was linked to longer operative times (MD 36.4 minutes; 95% CI 3.4-69.4; p = 0.03). No significant differences were found in hospital stay (MD -0.5 days; 95% CI -2.1 to 1.1; p = 0.57), blood loss (MD -2.1; 95% CI -9.6 to 5.4; p = 0.58), or local recurrence (OR 0.44; 95% CI 0.07-3.01; p = 0.405). In conclusion, NOSE offers advantages such as reduced postoperative pain, lower SSI rates, and faster bowel recovery, with prolonged operative time as its main limitation. These findings support NOSE as a viable alternative to CVT for right-sided colon cancer without compromising safety or long-term outcomes.

Comparison of postoperative inflammatory response between natural orifice specimen extraction surgery and conventional laparoscopy in the treatment of colorectal cancer: a meta-analysis and systematic review

PURPOSE

Natural orifice specimen extraction surgery (NOSES) has attracted attention because of its minimal invasiveness. This meta-analysis compared inflammatory response profiles and infectious complications between colorectal cancer patients treated with NOSES and those treated with conventional laparoscopy.

METHODS

Seven medical databases were searched up to February 2024. The authors included studies that examined changes in the inflammatory response and outcomes in the patients after NOSES surgery. The Cochrane tool and the Newcastle-Ottawa Scale were used to evaluate the quality of the studies. Pooled standardized mean differences and odds ratios with 95% CIs were calculated using either fixed- or random-effects models. Review Manager 5.4 (RevMan 5.4) and the R project were used for the meta-analysis.

RESULTS

This meta-analysis included 22 studies. Pooled analyses revealed lower tumor necrosis factor-α levels (SMD=-1.34,95% CI [-2.43, -0.25]; Z=2.40, P =0.02 and SMD =-1.49,95% CI [-2.15, -0.82]; Z=4.36, P <0.0001) and C reactive protein levels (SMD=-0.56, 95% CI [-4.17, -2.50]; Z=2.19, P =0.03 and SMD =-1.24,95% CI [-1.77, -0.71]; Z=4.56, P <0.00001) on postoperative day 1 and postoperative day 3 for NOSES than for conventional laparoscopy. Pooled analysis revealed significantly lower interleukin-6 levels in the NOSES group (SMD=-1.88,95% CI [-2.84, -0.93]; Z=3.88, P =0.0001) on postoperative day 3. There were no significant differences in white blood cell count, procalcitonin levels, or the incidence of infectious complications between the two groups.

CONCLUSIONS

NOSES has a superior inflammatory profile and does not increase the incidence of postoperative infectious diseases. The reported results should be validated in a larger population of colorectal cancer patients.

Chronic postsurgical pain following gastrointestinal surgery - A scoping review

BACKGROUND

Chronic postsurgical pain (CPSP) has a great impact on quality of life and socioeconomic status. The mechanisms behind CPSP remain poorly understood, however type of surgical intervention seems to play a role. Gastrointestinal surgeries are common procedures, yet research in CPSP following gastrointestinal surgery is limited. The objective of this scoping review was to map the current literature on CPSP following gastrointestinal surgery, identifying how CPSP have been investigated, and which evidence gaps exist.

METHODS

This scoping review followed a pre-published protocol and PRISMA-ScR guidelines. A search was carried out in Medline, Embase, CINAHL, Cochrane Central, Clinicaltrials.Gov, and Google Scholar. Eligible studies were original studies involving adults, undergoing gastrointestinal surgery, who had a pain assessment ≥30 days postoperatively. A two-phase screening process and data charting were done by two independent reviewers.

RESULTS

A total of 53 studies were included, published between 2001 and 2024, predominantly across Europe and Asia. The range of CPSP prevalence reported was 3.3%-46.1%. Only half the studies clearly defined CPSP, and the timing and manner of pain assessment varied considerably. Twenty-seven studies assessed risk factors for developing CPSP: preoperative pain and acute postoperative pain were consistently significant.

CONCLUSIONS

There was a wide consensus on CPSPs' negative impact on quality of life. CPSP following gastrointestinal surgery is prevalent and significantly impacts quality of life. Standardized definitions and methodologies to improve the comparability and reliability of the findings across studies are needed. Future research should focus on CPSP following specific surgical procedures to develop tailored prevention and treatment strategies.

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.

How to do laparoscopic right hemicolectomy with transvaginal natural orifice specimen extraction

The key steps of performing a laparoscopic right hemicolectomy with transvaginal natural orifice specimen extraction surgery.