Safety And Oncological Outcomes Of Laparoscopic Natural Orifice Specimen Extraction Surgery Compared With Conventional Laparoscopic Surgery For Colorectal Diseases

Objective: To evaluate the safety and oncological outcomes of laparoscopic colorectal surgery using natural orifice specimen extraction(NOSE)compared with conventional laparoscopic(CL)colorectal surgery in patients with colorectal diseases.Methods: We conducted a systematic search of PubMed,EMBASE and Cochrane databases for randomized controlled trials(RCTs),prospective nonrandomized trials and retrospective trials up to September 1,2018,and used 5-year disease-free survival(DFS),lymph node harvest,surgical site infection,anastomotic leakage,and intraabdominal abscess as the main endpoints.Subgroup analyses were conducted according to the different study types(RCT and NRCT [nonrandomized control trial]).A sensitivity analysis was carried out to evaluate the reliability of the outcomes.RevMan5.3 software was used for statistical analysis.Results: Fourteen studies were included(two RCTs,seven retrospective trials and five prospective nonrandomized trials)involving a total of 1435 patients.Compared with CL surgery,the NOSE technique resulted in a shorter hospital stay,shorter time to first flatus,less postoperative pain,and fewer surgical site infections and total perioperative complications.Anastomotic leakage,blood loss and intra-abdominal abscess did not differ between the two groups,while operation time was longer in the NOSE group.Oncological outcomes such as proximal margin(weighted mean difference [WMD]=0.47;95% confidence interval [CI]-0.49 to 1.42;P=0.34),distal margin(WMD=-0.11;95% CI-0.66 to 0.45;P=0.70),lymph node harvest(WMD=-0.97;95% CI-1.97 to 0.03;P=0.06)and 5-year DFS(hazard ratio=0.84;95% CI 0.54 to 1.31;P=0.45)were not different between the NOSE and CL surgery groups.Conclusions: Compared with CL surgery,NOSE may be a safe procedure,and can achieve similar oncological outcomes.Large multicenter RCTs are needed to provide high-level,evidence-based results in functional outcomes assessing anal or vaginal dysfunction and long-term oncological outcomes...