A Prospective Study Of Recent Bacteriological And Oncological Significance After NOSES For Robotic Rectal Cancer

Objective:To investigate the sterile and tumor-free effect of rectal cancer by Natural orifice specimen extraction surgery(R-NOSES),and to analyze the short-term clinical effect of the operation.Methods:The clinical data of 66 patients with rectal cancer treated in the Department of general surgery of the First Affiliated Hospital of Nanchang University from May2020 to March 2021 were prospectively analyzed.After the exclusion criteria,a total of 63 patients were successfully enrolled,including 32 cases of robot assisted radical resection of rectal cancer and 31 cases of robot assisted radical resection of rectal cancer.By comparing the basic data,perioperative data,postoperative pathological data,bacteriology and oncology indexes of the two groups,we analyzed whether the robot assisted radical resection of rectal cancer can achieve the similar aseptic and disease-free standard and short-term curative effect.Bacteriological analysis:bacterial culture was carried out by peritoneal lavage fluid after operation.The tumor cells were detected by postoperative peritoneal lavage fluid.Results:63 patients were successfully enrolled into the group,and all patients were successfully operated.There was no statistical significance in gender,age,BMI,ASA grade and postoperative T stage between the two groups(P > 0.05).In terms of bacteriology in the short term after operation,4 cases were positive in the bacterial culture results of peritoneal lavage fluid from 31 cases of robot assisted radical resection of rectal cancer,the positive rate was 12.9%,and 2 cases were positive in the bacterial culture results of peritoneal lavage fluid from 32 cases of robot assisted radical resection of rectal cancer,the positive rate was 6.25%,the difference was not statistically significant(P > 0.05).Two groups of patients with postoperative peritoneal lavage fluid oncology test,cytology test and chromosome test,two groups of positive cases were 0,the positive rate was 0,the difference was not statistically significant(P > 0.05).In both groups,compared with the R-LAP group,the blood loss in the R-Nose group was significantly lower(43.67±20.08 vs 62.36±29.01,P<0.05),and the VAS score on the first and third day after surgery was lower.VAS score on postoperative day 1(3.83 ± 0.75 vs 4.97 ± 0.73,P < 0.001);VAS score on postoperative day 3 was(1.90±0.85 vs 2.93±0.96,P < 0.001),and the difference was statistically significant.However,there were no significant differences between the two groups in operative time,postoperative exhaust time,postoperative first fluid intake time,postoperative catheter withdrawal time,postoperative drainage tube withdrawal time,postoperative hospital stay and postoperative complication rate(P >0.05).Conclusion:In terms of asepsis,the positive rate of bacterial culture after robotic Noses is higher than conventional robotic rectal cancer surgery,but it does not appear to cause significant additional abdominal contamination resulting in additional complications.In terms of tumor-free principle,robotic Noses can achieve the oncological effect similar to conventional robotic assisted radical resection of rectal cancer in the near future,and no tumor cell diffusion is found at present.In terms of short-term efficacy,Noses surgery is safe and feasible,which to a certain extent reduces the trauma to patients and the postoperative pain.It also has obvious advantages in overall aesthetics and is worth further promotion..