Short-term Outcomes And Quality Of Life Analysis After NOSESⅠ For Low Rectal Cancer Patients

Objective: To investigate the postoperative short-term outcomes,anal function and quality of life of laparoscopic lower rectal cancer resection with transanal natural orifice specimen extraction(NOSESⅠ).Methods: 120 patients with low rectal cancer treated in our hospital from December 2020 to August 2021 were collected.According to the inclusion and exclusion criteria,the patients were divided into control group(Conventional laparoscopy group)and experimental group(NOSES group).The operation method of the control group was laparoscopic Dixon operation for rectal cancer,and the experimental group was laparoscopic lower rectal cancer resection with transanal natural orifice specimen extraction(NOSESⅠ).The clinical data,postoperative anal function and quality of life follow-up data of all patients were collected and analyzed to further study the clinical outcomes,postoperative anal function and quality of life of patients undergoing NOSESⅠ.Results: There was no significant difference between the two groups in age,sex,BMI,distance from tumor to anus,operation time,amount of operation bleeding,number of lymph node biopsies and maximum diameter of tumor(P>0.05).At the same time,the postoperative specimens of the two groups showed that the mesorectum was intact,and the pathological examination of the postoperative specimens reported that the margins of both incisions were negative.However,compared with conventional laparoscopic group,NOSES group had earlier first ambulation time(P<0.001),earlier postoperative exhaust and defecation time(P=0.002),lower incidence of complications(5% vs 17%,P=0.04)and shorter hospitalization time(P=0.04);Moreover,the patients in the NOSES group had no auxiliary incision in the abdomen.Although more transanal operations were needed in the process of NOSES,there was no significant difference in LARS score,Williams anal function rating and Wexner anal incontinence score within half a year after operation between NOSES group and conventional laparoscopy group(P>0.05);At the same time,the quality of life of patients with fecal incontinence after operation was evaluated from the four dimensions of lifestyle change,coping/behavior restriction,depression/self perception and social embarrassment.There was no significant difference between the two groups within 1 month,3 months and 6 months after operation(P>0.05).And with the passage of time,the anal function of the two groups of patients gradually improved,and the quality of life in all dimensions was significantly improved.Conclusion: 1.Compared with conventional laparoscopic radical resection of rectal cancer(Dixon),laparoscopic lower rectal cancer resection with transanal natural orifice specimen extraction(NOSES I)has no significant difference in tumor radical resection,but in terms of short-term outcomes,NOSES I has the advantages of less abdominal trauma,less postoperative pain,less abdominal wall scars,rapid postoperative recovery,low incidence of complications and early discharge time,which is more in line with the concept of rapid rehabilitation surgery.2.There was no significant difference in anal function and fecal incontinence quality of life between the two groups.This suggests that NOSES I does not increase the risk of anal dysfunction.As long as we strictly grasp the indications of NOSES and standardize the operation,we can effectively avoid the injury of anal function.In addition,the patients in the NOSES group had less postoperative pain and earlier first ambulation time,and good psychological feeling brought by no abdominal incision,patients had better short-term quality of life.