| Objective:To compare the short-term outcomes between trans-anal and trans-abdominal specimen extraction in Da Vinci robotic-assisted surgery for rectal cancer,so as to explore the safety and effectiveness of robotic-assisted trans-anal specimen extraction for rectal cancer.Methods:A retrospective study was conducted to analyze the data of 135 patients who underwent robotic-assisted radical resection for rectal cancer in the Department of Anorectal Surgery of Gansu Provincial Hospital from Jan.2018 to Dec.2020.The specimens were extracted through the anus in the NOSES group(n=63)or through the abdominal incision in the control group(n=72).The patients’characteristics,intraoperative and postoperative data,complications,cost,pathological results,blood index and follow-up were compared between the two groups.Results:(1)There was no significant difference in the basic data and tumor features(including the distance between the tumor and the anus as well as its distribution,and the maximum diameter of the tumor)between the two groups(P>0.05).(2)Compared with the control group,the NOSES group had shorter flatus time[(46.14±15.75)h vs.(61.88±13.92)h,t=-6.161,P=0.047];less liquid diet time[(57.87±13.44)h vs.(68.63±12.94)h,t=-4.731,P=0.012];less postoperative ambulation time[(41.94±11.73)h vs.(52.17±10.67)h,t=-5.306,P<0.001];less postoperative hospital stay[(6.41±1.59)d vs.(8.63±1.72)d,t=-7.708,P<0.001].The pain on the 1st day after operation[(2.25±0.49)vs.(2.96±0.62),t=-7.253,P=0.005]and the 3rd day after operation[(2.97±0.32)vs.(3.85±0.60),t=-10.414,P<0.001]in the NOSES group was lower than that in the control group;The operation time of NOSES group was longer than control group[(194.22±12.05)min vs.(186.85±14.14)min],but there was no difference between the two groups(t=3.825,P=0.223).39 patients(61.9%)in the NOSES group were satisfied with the postoperative abdominal cosmetic effect,but compared to the control group,the difference was not significant(P>0.05).Between the two groups,there was no significant difference(P>0.05)in blood loss and anal function(3 months after operation).(3)No difference was observed between the two groups about the pathological results(P>0.05).(4)About the postoperative complications and cost,no difference was observed between the two groups(P>0.05).(5)The WBC in NOSES group was lower than that in control group on the 1st day after operation,but the difference was not significant(P>0.05);The IL-6 in NOSES group was lower[(21.41±0.93)ng/L vs.(23.09±1.12)ng/L,t=-9.368,P=0.013];and the PCT was lower[(0.86±0.22)ng/mL vs.(1.14±0.24)ng/mL,t=-7.294,P=0.035].On the 3rd day after operation,the WBC in the NOSES group was lower[(10.18±1.42)×10~9/L vs.(11.88±0.80)×10~9/L,t=-6.202,P<0.001];The IL-6 was lower[(16.43±1.59)ng/L vs.(17.93±1.07)ng/L,t=-6.492,P<0.001],and the PCT was lower[(0.32±0.27)ng/mL vs.(0.74±0.15)ng/mL,t=-7.223,P<0.001].Patients in the NOSES group were followed up for an average of 21.3 months,while 23.4 months in the control group.During the follow-up,there was no tumor recurrence and no serious complications.Conclusion:(1)Robot-assisted trans-anal NOSES for rectal cancer is safe and effective,and has better short-term clinical effect;(2)Compared with conventional robotic-assisted surgery for rectal cancer,robotic-assisted trans-anal NOSES has the advantages of faster recovery of gastrointestinal function,less pain,earlier time of ambulation,shorter postoperative hospital stay and better abdominal cosmetic effect;(3)Robotic-assisted trans-anal NOSES for rectal cancer can avoid incision-related complications and does not increase the risk of other complications,and there was no significant difference in anal function after surgery between the two methods. |
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