The Effects Between Natural Orifice Specimen Extraction And Conventional Laparoscopy For Colorectal Cancer: A Meta-analysis

Objective:To compare the clinical effects between natural orifice specimen extraction surgery(NOSES)and conventional laparoscopy(CL)in treating colorectal cancer.Methods: A search was performed on Wan Fang database,VIP,CNKI,Pub Med,The Cochrane Library,EMBASE and Science Direct.According to the inclusion and exclusion criteria,we collected the literature to compare the clinical effects of NOSES and CL in the treatment of colorectal cancer up to 31 December 2019.The meta-analysis was performed by Rev Man 5.3.Results: Twenty papers including 1890 patients were selected,905 patients in NOSES group and 985 patients in CL group.Meta-analysis showed that compared with conventional laparoscopy,NOSES had a longer time in operation[WMD=4.02,95%CI(0.20,7.84),P=0.04]but a lower bleeding during operation[WMD =-7.75,95%CI(-11.31,-4.19),P<0.00001].On the comparison of the first anal exhaust time [WMD =-0.89,95%CI(-1.14,-0.64),P <0.00001] and the days of hospitalization after operation [WMD =-1.65,95%CI(-2.25,-1.06),P <0.00001] shows that NOSES group were earlier.The VAS score on the first day [WMD=-1.47,95%CI(-1.78,-1.15),P<0.00001],the CRP [WMD=-16.97,95%CI(-26.43,-7.51),P=0.0004] and IL-6 index [WMD =-27.77,95%CI(-36.98,-18.56),P<0.00001]on the third day after operation showed that the NOSES group were lower.The overall incidence of postoperative complications in the NOSES group were smaller [OR=0.46,95%CI(0.34,0.61),P <0.00001].There was no significant difference between the two groups in lymph node yields [WMD =-0.29,95%CI(-0.81,0.23),P =0.27],postoperative three-year survival rates(P=0.21)and local recurrence of tumor(P=0.70).Conclusion: According to the meta-analysis,NOSES had an early exhaust time after operation,painless and lower stress after surgery,fewer complications compared with CL.NOSES could also reduce the hospital stay and had no obvious effect on the long-term survival of the patients.NOSES surgery is safe,feasible and worthy of clinical application.