Laparoscopic Surgery With Or Without Natural Orifice Specimen Extraction For Colorectal Tumor:a Meta-Analysis

Objective:Our investigation is aimed to compare clinical effects of laparoscopic surgery with or without natural orifice specimen extraction (NOSE) for patients with colorectal tumor through a meta-analysis.Methods:A search was performed in PubMed, Web of Science, Cochrane Register of Controlled Trials(CENTRAL), China National Knowledge Infrastructure (CNKI), VIP and WANFANG databases for eligible studies. Operation time, loss of blood, number of cleaned lymph nodes, time to first flatus, use of pain killer, duration of hospital stay, postoperative complications, disease-free survival (DFS) and cosmetic scores were the main endpoints. The results were analyzed using RevMan v5.2.Results:Ten clinical studies involving 868 patients were included for final analyses. Laparoscopic resection with NOSE had advantages of a shorter time to first flatus (WMD=-0.45days,95%CI=[-0.74,-0.16],p=0.003),less use of pain killer (OR=0.46,95% CI=[0.29,0.74], p=0.001), less postoperative complications (OR=0.32,95%CI= [0.20,0.51],p<0.00001), and better cosmetic results (p<0.05), while no significant difference was observed in aspects of loss of blood, number of cleaned lymph nodes and DFS of 3 years (WMD=-10.86ml,95%CI=[-25.43,3.71],p=0.14;WMD=0.36,95%CI= [-0.21,0.92], p=0.21; p=0.746). According to sites of specimen extraction, patients undergoing NOSE surgery were divided into two subgroups for following analysis. Then we found that transanal group had a shorter duration of hospital stay than conventional laparoscopy (WMD=-1.07days,95%CI=[-1.99,-0.16], p=0.02). But there was no difference in the aspect of operation time between transanal group and conventional laparoscopy (WMD=-1.21min,95%CI=[-14.44,12.03], p=0.86). As for transvaginal group, operation time was significantly longer than conventional laparoscopy (WMD=33.39min,95%CI=[6.95,59.83],p=0.01).Conclusions:Our meta-analysis supported the notion that laparoscopic resection with NOSE for colorectal tumor can significantly accelerate postoperative recovery, result in less postoperative pain, fewer complications and higher cosmetic scores; Furthermore, transanal specimen extraction can shorten the duration of hospital stay when compared with conventional laparoscopy.