Observation Of The Short-term Curative Effect Of Natural Orifice Specimen Extraction Surgery In Colorectal Cancer

Background:Colorectal cancer is a common tumor in China.At present,laparoscopic surgery has gradually become the main surgical method for colorectal cancer due to its characteristics of minimally invasive,fast recovery and no noted difference in curative effects compared with open surgery.However,traditional laparoscopic surgery still has the abdominal auxiliary incision,which brings difficulties to continue to reduce the surgical trauma.The development of natural orifice specimen extraction surgery(NOSES)has further reduced the surgical trauma of colorectal cancer.However,currently,natural orifice specimen extraction surgery has not been widely used in the treatment of colorectal cancer,and more clinical studies are needed to clarify its surgical safety and therapeutic effect for further promotion.Objective:By observing the short-term postoperative efficacy of colorectal cancer patients treated by NOSES in our center,and comparing with those who underwent traditional laparoscopic surgery,this study provides a reference for the application and promotion of natural orifice specimen extraction surgery in the treatment of colorectal cancer.Methods:The clinical data of patients undergoing radical resection of colorectal cancer in the first patient area of general surgery,Qilu hospital,Shandong University from April 2017 to February 2019 were retrospectively analyzed.Depending on the surgical procedure,the patients were divided into two groups,one is conventional laparoscopic group and another is NOSES group.Then,depending on the date of surgical,we divided the NOSES group into two subgroups:former group(32 cases)and latter group(33 cases).Compare two groups of preoperative,intraoperative and postoperative clinical data,by observing the operation time,number of lymph node dissection,postoperative anastomotic healing,exhaust time,the first leaving bed time,hospitalization days,hospitalization expenses,postoperative pain(VAS score,the use of analgesic drugs),postoperative bowel function evaluation(Wexner incontinence score),and other indicators,evaluation NOSES surgery and conventional laparoscopic surgery in the near future curative effect.Results:This study collects 95 cases of patients meeting the standard,including 65 cases in the NOSES surgery group and 30 cases in the conventional laparoscopy group.The P values of BMI.age.gender and complications in the two groups were all greater than 0.05,with no statistical difference.There were no statistically significant differences between the NOSES group and conventional laparoscopic group in hospitalization days after surgery,hospital expenses,time of urethral tube extraction,postoperative pain score,time of gastric tube extraction,time of drainage tube extraction,fever after tube extubation,whether analgesic drugs were added,complications and number of lymph node dissection.The distribution of the first leaving bed time in the conventional laparoscopy group was statistically different from that in the NOSES surgery group,and the first leaving bed time in the traditional laparoscopy group were lower than that in the NOSES surgery group(2.77 0.82 vs 1.77 0.66.P<0.001)significantly.Exhaust time was statistically different in the traditional laparoscopic group and the NOSES surgery group,and the first exhaust time in the traditional laparoscopic group was significantly later than that in the NOSES surgery group(2.83 0.75 vs 2.43 0.75,P<0.001).The operating time of NOSES group was significantly extended compared with conventional laparoscopy group(248.80 45.79 vs 224.83 52.02,P=0.025).The number of anal drainage placement in NOSES group was significantly higher than that in the conventional laparoscopic group[(38,no 27)vs(6,no 24),P<0.001].Subgroup analysis displayed that there was no significant difference in operating time between the latter group and the conventional laparoscopy group(239.55 44.09 vs 224.83 52.02,P=0.229).The number of anal drainage placed of former group was significantly higher than that in the latter group[(26,no 6)vs(12,no 21),P<0.001].This method carries a higher number of anal drainage placement in the former group than in the conventional laparoscopic group[(26,no 6)vs(6,no 24),P<0.001].This method showed no significant difference in the number of anal drainage placement between the latter group and the conventional laparoscopic group(P=0.151)in statistics.There was no obvious difference in anal function scores in the 3 months follow-up between the NOSES group and the conventional laparoscopy group.Conclusion:In the short-term efficacy of NOSES operation in the surgical treatment of colorectal cancer,the first ground movement and the first exhaust time are better than conventional laparoscopic surgery,and there is no significant difference in the incidence of complications of anastomotic fistula,abdominal bleeding,postoperative anal function and other indicators between this operation and conventional laparoscopic surgery.NOSES surgery is a safe,less traumatic,faster recovery procedure,which is worth popularizing in the treatment of colorectal cancer.NOSES has a learning curve.In the process of development and promotion,physicians with certain experience in laparoscopic surgery should carry out and pay attention to the summary and exchange.