The Clinical Efficacy Of Laparoscopic Natural Orifice Specimen Extraction Surgery In The Treatment Of Colorectal Cancer

Objective:To compare the clinical efficacy of natural orifice specimen extraction surgery（NOSES）with laparoscopic small incision in colorectal cancer surgery,and provide guidance for clinical practice.Method:In this study,a total of 57 patients who were admitted to the Gastrointestinal Colorectal Anal Surgery Department of China-Japan Union Hospital Jilin University from January 2019 to December 2020 and were diagnosed with colorectal cancer and met the inclusion criteria were selected.The data of 57 patients were retrospectively analyzed,and the patients were divided into groups according to different surgical methods.Among them,30 patients in the observation group received natural orifice specimen extraction surgery（NOSES）,and 27 patients in the control group received laparoscopic small incision surgery.Intraoperative blood loss,operation time,sum of incision length,hospitalization days,total hospitalization expenses,first postoperative exhaust time,VAS pain scores on the first postoperative day,first postoperative landing time,postoperative complications（incision complications,anastomotic leakage,intestinal obstruction,abdominal infection,pulmonary infection,lower extremity deep venous thrombosis）,the number of lymph nodes dissected by surgery,the positive rate of upper and lower resection margins,short-term recurrence and metastasis were collected.Statistical analysis was performed using SPSS 25.Results:1.The difference in operation time and the length of abdominal incision between the two groups was statistically significant（P<0.05）,but there was no significant difference in intraoperative blood loss between the two groups（P>0.05）.The operation time in the NOSES group was longer than that in the small incision group,and the abdominal incision length in the NOSES group was shorter than that in the small incision group.2.Postoperative recovery: There were statistically significant differences in the VAS scores on the first day after surgery,the first anal exhaust time,first postoperative landing time,hospitalization days,and total hospitalization expenses（P<0.05）,and the NOSES group was lower than the small incision group.3.Postoperative complications: There were no significant differences in postoperative incision complications,anastomotic leakage,abdominal infection,pulmonary infection,intestinal obstruction,and lower extremity venous thrombosis between the two groups（P>0.05）.4.There were no significant differences in the number of lymph nodes dissected during surgery,the positive rate of the upper and lower margins,the recurrence and metastasis rates,and the 2-year disease-free survival rate（P>0.05）.Conclusions:1.NOSES can reduce the length of the postoperative abdominal incision,reduce trauma and increase aesthetics,which matches the concept of minimally invasive surgery.2.Compared with the perioperative indicators of laparoscopic small incision treatment of colorectal cancer,although NOSES prolongs the operation time,it has less postoperative pain,earlier recovery of gastrointestinal function,faster postoperative recovery,shortened hospitalization days,and reduced hospitalization cost,which is compatible with the concept of ERAS.3.Compared with the laparoscopic small incision treatment mode,it does not increase the incidence of postoperative complications.4.In terms of tumor recurrence and metastasis,and 2-year disease-free survival rate,NOSES can achieve the same effect as laparoscopic small incision in the treatment of colorectal cancer.5.The surgical treatment of colorectal cancer by NOSES has obvious advantages,has a bright and wide application prospect,and is worthy of clinical promotion.