Prospective Randomized Controlled Trial Of Laparoscopic-assisted Radical Left Colorectomy Transanal Specimen Extraction Using The Cai Tube

Objective To prospectively evaluate the feasibility and efficacy in laparoscopic-assisted natural orifice specimen extraction(LA-NOSE)and conventional laparoscopy(CL).Methods Prospective randomized controlled study methods,in October 2015 to December 2016,the hospital's surgery patients into the group of 40 patients with left colorectal cancer using the random number table method produces 1 ~ 40 digital random order.According to the order of the patients,the order was divided into the la-nose group(20 cases)and the conventional laparoscopy assisted left colorectal cancer radical surgery group in 20 cases(CL group).The clinical data of patients were collected,and the operation time of the two groups,the negative rate of peripheral incision,the number of lymph node dissection,the estimated amount of bleeding in the operation,and the CRP value of the second day after surgery were compared.Bed activity time,exhaust time,postoperative eating time,postoperative pain,length of hospital stay,the length of the total cost,the postoperative complications and anal function of several indicators,and follow-up,and observe the clinical curative effect.Results Forty patients were enrolled in the study,20 in each group.There was no significant in the the tumor diameter,number of lymph nodes retrieved,the length of distal or proximal resection margin,the rate of circumferential resection negative margin,the operating time,blood loss,postoperative anal function,postoperative hospital day,the hospital fee and the postoperative complicationrate(P<0.05).The study group presented lower levels of postoperative C-reactive protein(52.0 ±31.3mg/L vs.72.9±33.0mg/L,P<0.05),shorter time to passage of flatus and take liquid [(2.5±0.5)d vs.(3.4±1.2)d,P<0.05;(4.3±1.5)d vs.(5.7±1.6)d,P<0.05],shorter time of leaving bed[(2.9±0.7)d vs.(3.6±0.9)d,P<0.05],lower postoperative pain score on postoperative day 1,postoperative day 3,postoperative day 7(P<0.05),shorter time of postoperative pain(6.2 vs.8.3 d,P<0.05),lower rate of utilization of analgesic in addition to postoperative analgesia pump(1/20 vs.7/20,P<0.05);Two groups of patients with preoperative and postoperative peritoneal lavage fluids(PLF)were not found in tumor cells and bacterial contamination.Conclusion LA-NOSE colorectal cancer radical surgery is performed as a natural way to collect specimens.No obvious surgical scar,postoperative pain was significantly reduced.It does not increase postoperative abdominal bacterial contamination and abdominal infection.One month of observation did not increase tumor peritoneal planting.Therefore,it is safe and feasible to have a good indication of surgical indications.