Comparative Study Between Noses And Laparoscopic Surgery With Small Incision In Colorectal Cancer

Background:Colorectal Cancer(CRC)is one of the most common malignancies in human digestive system,and rectal cancer accounting for 75% of all Colorectal malignancies in China.At present,referring to several guidelines on the diagnosis and treatment of colorectal cancer(CSCO,ESMO,NCCN),it is clearly pointed out that the treatment of curable colorectal cancer is a comprehensive treatment which mainly base on surgery.Surgical techniques range from traditional open surgery to laparoscopic surgery,and laparoscopic surgery from traditional laparoscopic surgery to reduced-port laparoscopic surgery or laparoscopic single-site surgery,the surgical method is gradually developing towards the direction of minimally invasive or even non-incisional.Resection of colorectal cancer through Natural orifice(natural orifice specimen extraction surgery,NOSES)is the classic method of no-incision surgery,but this method is still controversial,especially in the area of Asepsis and no neoplasm,its safety and feasibility still need more clinical data to support.Objective:To compare operation time,blood loss during operation,total length of abdominal incision,the VAS pain scores on the first day after surgery,first time of anal exhaust after surgery,feeding time after surgery,time of pulling out urinary catheter,hospital stays after surgery,postoperative complications such as anastomotic leakage,abdominal infection and so on.To clarify the short-term clinical efficacy between NOSES and Laparoscopic surgery with small incision in colorectal cancer.METHODS:60 patients with colorectal cancer who met the criteria of this study were divided into two groups: Noses Group and Laparoscopic surgery with small incision group.Each group had 30 patients,who underwent laparoscopic radical resection of colorectal cancer,in Noses Group,specimens were taking out through natural orifice,and in Laparoscopic surgery with small incision Group,specimens were taking out through new small abdominal incision.The operative parameters(operation time,blood loss during operation,total length of abdominal incision),postoperative recovery index(VAS pain score on the first day after surgery,time of first anal exhaust after surgery,postoperative feeding time,time of pulling out urinary catheter after surgery,days of hospital stays after surgery,complications such as anastomotic leakage and abdominal infection,etc,were analyzed,SPSS23.0 statistical software was used to process these data,t test was used to analyze the operative index,postoperative recovery index,?2 test was used to analyze the postoperative complications,and so on.When p < 0.05,the difference of the analysis data was statistically significant,the data were drawn into a bar chart or a grid chart to explore the differences in clinical outcomes between the two methods.RESULT:1.The entire data of 60 patients with colorectal cancer were analyzed.There were no important differences in sex,age of the two groups(p > 0.05).2.Tumor Index: There were no important differences in pathological stage,distance from anus between two groups(p > 0.05).3.Nutritional Index: There was no important difference in preoperative BMI(p > 0.05).4.Operative parameters: There were important differences in operation time,blood loss during operation and total length of abdominal incision between the two groups(p < 0.05).The operation time of Noses Group was 231.21±41.44 min,that of Laparoscopic surgery with small incision group was 200.17±27.19 Min,blood loss during operation in NOSES group was 43.53±13.11 ml,and that of Laparoscopic surgery with small incision group was 83.57±39.93 ml,and the total length of abdominal incision in NOSES Group was3.98 ±0.44 cm,the total length of abdominal incision in Laparoscopic surgery with small incision Group was 8.12 ± 0.56 cm.5.The Postoperative Recovery Index: There were important differences in VAS pain score on the first day after surgery,first time of anal exhaust after surgery,postoperative feeding time,and hospital stays after operation between the two groups(p < 0.05),the VAS pain score on the first day after surgery was 1.80±0.99 in NOSES Group,the VAS pain score on the first day after surgery of the Laparoscopic surgery with small incision group was5.57±1.87,the first time of anal exhaust after surgery was 39.60±8.19 h in NOSES Group,80.77±8.27 h in Laparoscopic surgery with small incision Group,respectively,the postoperative feeding time in NOSES Group was 54.43±10.66,that of Laparoscopic surgery with small incision Group was 77.63±10.56 hours,the hospital stays after surgery in NOSES Group was 5.36±4.95 days,and the hospital stays after surgery in Laparoscopic surgery with small incision Group was 8.62±2.03 days;There was no important difference in the time of pulling out urinary catheter after surgery between the NOSES group and the Laparoscopic surgery with small incision group(p >0.05).6.Complications: one case of anastomotic leakage occurred in NOSES group,one case of anastomotic leakage,and one case of incision infection in Laparoscopic surgery with small incision group,there was no significant difference in the number of complications between the two groups(p >0.05).CONCLUSION:1.Compared with laparoscopic surgery with small incision in colorectal cancer,NOSES has less postoperative pain,better recovery of intestinal function and shorter hospital stay,which is more minimally invasive,and more in line with the concept of rapid recovery.2.There was no difference in tumor index and postoperative complications between NOSES group and laparoscopic surgery with small incision group.Noses is safe and feasible,and has the value of popularization and application.