Bacteriological And Oncological Evaluation Of Laparoscopic NOSES For Colorectal Cancer

Objective: To investigate whether Laparoscopic radical resection of colorectal cancer by NOSES(via anus)can increase the risk of Postoperative intra-abdominal infection(PIAI)caused by intestinal bacteria translocation and abdominal implant metastasis caused by tumor cells translocation,as well as the effect of this operation on the immune stress of patients.Methods: A retrospective analysis of the clinical data of 43 cases of Conventional laparoscopic-assisted radical operation for colorectal cancer(CLA)and 26 cases of Laparoscopic radical resection of colorectal cancer by NOSES(La-NOSES)was diagnosed in three gastroenterology departments of he first affiliated hospital of Wannan Medical College from September 2017 to December 2019 were analyzed retrospectively.The clinical and pathological features,perioperative parameters,bacteriological and oncological results,as well as inflammatory and immunological indexes were collected and compared.The results of oncology were evaluated by peritoneal lavage exfoliative cytology(EC)and Flow cytometric DNA(FCM-DNA)analysis.The bacteriological results were evaluated by general bacterial and anaerobic culture of the peritoneal washings after surgery,and the inflammatory parameters were evaluated by measuring the pre-operation and post-operation levels of C-reactive protein(CRP)and Procalcitonin(PCT)in the blood of the patients.Immunological parameters were assessed by measuring the pre-operation and post-operation level of T lymphocyte subsets(CD3,CD4/CD8)in the patient's blood.Results: Bacterial culture results of 26 cases of La-NOSES were positive in 7 cases,with a positive rate of 26.92%.The results of bacterial culture in 43 patients with CLA were positive in 10 cases,with a positive rate of 23.25% and no statistically significant difference(p>0.05).The positive rate of EC test and FCM-DNA analysis were 0 in both groups.On the second day after the operation,CRP and PCT levels in the La-NOSES group were significantly higher than those in the CLA group,and the differences between the two groups were statistically significant(p<0.05).On the post-operation second day,both CD3 and CD4/CD8 in the La-NOSES group were higher than those in the CLA group,and the difference between the two groups was statistically significant(p<0.05).Conclusion:Laparoscopic radical resection of colorectal cancer by NOSES does not increase the risk of peritoneal contamination caused by ectopic peritoneal cavity of intestinal bacteria and the separation of tumor cells in peritoneal cavity causing the implantation of peritoneal tumor cells.La-NOSES may cause a higher inflammatory stress response in the short term after surgery,but it will eventually reduce or even return to normal state with postoperative treatment.La-NOSES has little effect on the immune system of patients,which is beneficial to reduce the possibility of postoperative infectious complications and promote the recovery of patients.The results of early bacteriology,oncology,inflammation and immunoassay showed that Laparoscopic radical resection of colorectal cancer by NOSES is safe and feasible.