Clinical Analysis Of Transvaginal Specimen Extraction Under The Guidance Of ERAS Concept In The Treatment Of Colorectal Cancer

Objective:To explore the safety,feasibility and short-term clinical efficacy of transvaginal specimen extraction(TVSE)compared with traditional laparoscopic resection,based on the concept of enhanced recovery after surgery(ERAS).Methods:Retrospective selection of clinical data of patients with colorectal tumours who underwent laparoscopic surgery by the same medical group at the Department of Gastroenterology and Hernia Surgery,the First Affiliated Hospital of Kunming Medical University from December 2017 to May 2022.A total of 74 cases were included in the study.According to the different methods of taking specimens,they were divided into two groups.Both groups of patients referred to the guidelines for enhanced recovery after surgery during the perioperative period,and combined with the actual development of the department,the perioperative management guided by the theory of enhanced recovery after surgery was carried out according to the unified standard.26 cases were included in the observation group(NOSES group),complete laparoscopic radical resection of colorectal cancer NOSES,vaginal specimen collection without auxiliary incision on the abdominal wall;and the remaining 48 cases were included in the control group(traditional laparoscopic group):traditional laparoscopic assisted radical resection of colorectal cancer.Collect and analyze the preoperative data(age,Body Mass Index(BMI),preoperative Carcinoembryonic Antigen(CEA),basic diseases,nutritional assessment,etc.),intraoperative related indicators(surgical method,specimen extraction method,average operation time and average blood loss,etc.),postoperative pathological data(postoperative pathological type,TNM stage,circumferential resection margin,number of cancer nodules,total number of lymph nodes dissected,nerve invasion,vascular invasion,etc.),postoperative Visual Analogue Score(VAS)score,postoperative analgesia,postoperative peritoneal drainage fluid bacteriological culture,inflammatory index comparison(Neutrophil-lymphocyte Ratio(NLR),C-reactive Protein(CRP)),postoperative recovery index,short-term complication rate(postoperative infection,bleeding,intestinal obstruction,rectovaginal fistula,etc.);economic indicators(total hospitalization costs,surgery-related costs);postoperative short-term functional evaluation(incision satisfaction),short-term local tumor recurrence and survival data were obtained by telephone and electronic case system.All were analyzed and compared using SPSS25.0 statistical software.Results:In this study,a total of 74 patients were included this.26 cases in the NOSES group and 48 cases in the traditional laparoscopic group.(1)There was no significant difference in age,body mass index,T stage,ASA rating,NRS2002 nutritional score,CEA level,tumor location and circumferential diameter,preoperative complications between the two groups(all P>0.05),and the baseline information was comparable.(2)There differences in intraoperative observation indexes(operation time,intraoperative bleeding)and postoperative pathological conditions(TNM stage,number of lymph node dissection,number of cancer nodules,whether nerve invasion,whether vascular invasion)between the two groups were no significant(all P>0.05).(3)Postoperative recovery indicators:patients in the NOSES group were able to remove the catheter earlier than the traditional laparoscopic group,exhaust and defecate,restore food intake and get out of bed,and these results were statistically significant(all P<0.001).The VAS scores of the NOSES group on the 1 st,2 nd and 3 rd day after operation were lower than those of the traditional laparoscopy,and the difference was significant(all P<0.001).The average postoperative hospital stay(7.27±1.82 days vs.9.98±2.40 days)was significantly different(all P<0.001).The use of additional analgesics was lower in the NOSES group(19.2%vs.56.3%,P<0.001).(4)Inflammatory indicators:The positive rate of bacterial culture in abdominal drainage fluid of NOSES group was lower(11.5%vs.12.5%,P>0.05).Pre-operative CRP and NLR were not significantly different between the two groups.(both P>0.05).The two inflammatory laboratory indexes of CRP on the third day after operation and NLR on the third day after operation in the NOSES group were lower than those in the traditional laparoscopic group,and they were statistically significant(all P<0.05).(5)Postoperative complications:There were 7(14.6%)cases of incision infection or poor prognosis in the traditional laparoscopic group and 0 in the NOSES group,and their difference was statistically significant(P=0.047).Other common postoperative complications(nausea and vomiting,rectovaginal fistula,etc.)was no significantly unlike(all P>0.05).The total incidence of postoperative complications in the NOSES group differ significantly from that in the control group(11.5%vs.41.7%,P=0.008).(6)The NOSES group had higher satisfaction with the incision,and no difference in statistical results(P=0.04).(7)Economic indicators:The average operation-related costs and average total hospitalization costs of the NOSES group were higher than those of the traditional laparoscopic group,and no significant difference in statistical results(both P>0.05).(8)Follow-up is finished by telephone and through an electronic case system.Follow-up to December 2022,there were no deaths in both groups,and the results showed no local recurrence.1 case(2.83%)had lung metastasis in the control group,and the short-term recurrence and metastasis rate have no statistical difference results(P>0.05).Conclusion(s):The transvaginal NOSES group under the guidance of ERAS concept has a positive short-term clinical effect in laparoscopic radical resection of colorectal cancer.It has obvious advantages such as reducing postoperative pain,accelerating postoperative rehabilitation,and enhancing the aesthetic satisfaction of abdominal wall incision.There is no difference in tumor recurrence and metastasis in the short term after operation.Transvaginal specimen extraction under the guidance of ERAS theory is safe and feasible in the treatment of colorectal cancer,which will be worthy of further clinical research and promotion.