The Safety Of Transanal Compared With Transabdominal Specimen Extraction In Laparoscopic Radical Resection Of Rectal Cancer: A Meta-analysis

Objective:Meta analysis was used to analyze the related indicators between transanal(NOSES)and transabdominal specimen extraction in laparoscopic radical resection of rectal cancer,including operation time,intraoperative blood loss,number of lymph node dissection,postoperative complications,postoperative gastrointestinal recovery time,postoperative pain score,postoperative hospital stay,postoperative anal function,recurrence rate and survival rate,to evaluate the feasibility,safety and effectiveness of laparoscopic radical resection of rectal cancer combined with transanal natural orifice specimen extraction surgery.Methods:The related literatures of transanal compared with transabdominal specimen extraction in laparoscopic radical resection of rectal cancer were searched in the databases of Cochrane,Embase,Pub Med,CBM,CNKI and Wanfang.After screening,the literature quality was scored,and finally included in the study according to the quality score results.According to the choice of operation,the patients were divided into NOSES group and traditional laparoscopy group.The related indicators were analyzed by using Review Manager5.4 tool software,to evaluate the clinical efficacy and safety of transanal NOSES in laparoscopic radical resection of rectal cancer.Results:Finally,17 studies(4 randomized controlled trials and 13 clinical controlled trials)were included,with a total of 1426 people(640 in NOSES group and 786 in traditional laparoscopy group).Meta analysis showed that the total incidence of postoperative complications in the NOSES group was significantly lower than that in the traditional laparoscopy group(OR=0.43,95%CI [0.31,0.59],P < 0.00001).The total postoperative complications were analyzed by correlation subgroup analysis,and the incidence of postoperative anastomotic complications included anastomotic bleeding,fistula,stricture(OR=1.09,95%CI [0.66,1.78],P=0.74>0.05),abdominal infection(OR=0.3,95%CI [0.13,1.10],P=0.07>0.05),abdominal bleeding(OR=0.72,95%CI[0.28,1.87],P=0.50>0.05),postoperative intestinal obstruction(OR=0.52,95%CI [0.17,1.53],P=0.23>0.05).There were no significant difference in the incidence of urinary system complications,including urinary tract infection and urinary retention(OR=0.70,95%CI [0.30,1.62],P=0.42>0.05),pulmonary infection(OR=0.77,95%CI [0.35,1.72],P=0.30>0.05).There were significant differences in the incidence of incision complications,including incision infection,bleeding,incision fat liquefaction and incision hernia(OR=0.19,95%CI [0.09,0.39],P<0.00001).The incidence of incision-related complications decreased.There was no statistical difference in the operation time(MD=4.28,95%CI [-4.27,12.83],P=0.33>0.05)and the number of lymph node dissection(MD=-0.05,95%CI [-0.38,-0.28],P=0.76>0.05).The intraoperative blood loss(MD=-12.17,95%CI [-19.36,4.97],P=0.0009<0.05)was significantly lower than that of the control group.The postoperative hospital stay was significantly shorter than that of the control group(MD=-2.14,95%CI [-2.65,1.63],P<0.0001).There were statistical differences in the pain score on the first day after operation with VAS scale(MD=-1.41,95%CI[-1.651.65],P<0.00001)and with NRS scale(MD=-1.11,95%CI[-1.30,-0.93],P<0.00001),and the pain score was lower.There was statistical difference in the first postoperative anal exhaust time(MD=-0.61,95%CI [-0.80,0.42],P<0.00001),and the postoperative anal first exhaust time was shortened.There was no significant difference in anal function score of 6 months after operation(MD=0.09,95%CI[-0.51,0.70],P=0.76>0.05)and 2-year survival rate(OR=1.49,95%CI [0.63,3.40],P=0.35>0.05).Conclusion:The results of Meta analysis showed that there were no significant difference in operation time,number of lymph nodes dissection,total incidence of postoperative complications,anal function score of 6 months after operation and 2-year survival rate between NOSES group and traditional laparoscopy group,but there were statistically significant,less intraoperative blood loss,shorter postoperative hospital stay,lower postoperative pain score on the first day,shorter postoperative exhaust time and lower incidence of incision-related complications.The results support that transanal specimen extraction in laparoscopic radical resection of rectal cancer was not only safe and feasible,but also less blood loss,less incision-related complications and less postoperative pain.it shortens the postoperative gastrointestinal recovery time and postoperative discharge time,and is more minimally invasive.