Analysis Of The Short-term Effect Of Laparoscopic Resection Of Colorectal Cancer With Natural Orifice Specimen Extraction Surgery(NOSES)

Research background and purpose:The aim of this research is to clarify the indications and contraindications,surgical classification and selection of operation methods,surgical equipment and instrument requirements,and analyze the unique advantages and problems of natural orifice specimen extraction surgery(NOSES)by comparing the short-term effects of laparoscopic resection of colorectal cancer with NOSES and traditional laparoscopic colorectal cancer radical surgery,for making more clinical contribution to the promotion of the natural orifice specimen extraction surgery.Materials and Methods:The colorectal cancer patients'clinical data who underwent surgical operation in Sichuan cancer hospital from July 2017 to February 2019 was collected retrospectively.On the basis of the different operation methods,two groups of the patients were divided:laparoscopic resection of colorectal cancer with natural orifice specimen extraction surgery group(NOSES group)and traditional laparoscopic colorectal cancer radical operation group(traditional laparoscopic group),analyzing according to 1:2 ratio.We collected the general clinical data(BMI,tumor markers,etc.),intraoperative data(operative time,intraoperative blood loss,etc.),postoperative pathological data(staging,nerve invasion,etc.),postoperative clinical results(postoperative pain score,first time to eat,etc.),postoperative complications(abdominal bleeding,pulmonary infection,etc.)and postoperative anal function evaluation for three months and whether the tumor recurrence or metastasis.To analyze whether there is statistical difference or not between the above-mentioned groups,and then assess the short-term effects of NOSES.Results:1.This study included 150 patients:50 in the NOSES group and 100 in the traditional laparoscopic group.Statistic analysis demonstrated that two groups of patients in gender(P=0.487),age(P=0.365),body mass index(P=0.200),preoperative CEA(P=0.973),preoperative CA199(P=0.707),preoperative CA125(P=0.410),distance between tumor and anal margin(P=0.597),preoperative hypertension,type 2diabetes,coronary atherosclerotic heart disease(P=0.716,0.608,0.843)and other indicators have no statistical difference.2.The operation of all the patients was successful,and no one died in the perioperative period.There was no statistical difference in the intraoperative blood loss between the two groups(P=0.089),and no intraoperative blood transfusion was performed in all patients.The average operative time of the NOSES group was longer than that of the traditional laparoscopic group(244.30±25.79 min vs 185.62±60.03 min,T=6.606,P<0.001),and the difference showed notable statistical significance.3.The postoperative pathological results of all patients showed that the circumcision margin were negative,which satisfied the requirements of radical treatment.The postoperative pathological stages of the two groups had significant difference and the NOSES group was earlier than the traditional laparoscopic group(X~2=8.737,P=0.013).The number of cancer nodes,lymph nodes,positive lymph nodes,nerve invasion,vascular invasion and microsatellite detection between the two groups(P=0.083,0.844,0.240,0.843,0.877,0.549)also displayed no statistical difference.4.No statistical differences were demonstrated in the postoperative hospital stay(P=0.160),the time of catheter removal(P=0.072),resetting catheter(P=0.274),installing gastric tube(P=0.767),the time of stomach tube removal(P=0.494),installing anal tube(P=0.423),the time of anal tube removal(P=0.589),the time of feeding firstly(P=0.645),the time of exhaust firstly(P=0.076),and the time of defecation firstly(P=0.136),the using time of analgesia pump(P=0.888),the using time of drainage tube(P=0.875)in the two groups.All patients had no fever after removing the drainage tube.The time of getting out of bed after operation firstly in the NOSES group was earlier than that in the traditional laparoscopic group,with a significantly statistical difference(1.84±0.47 d vs 2.50±0.60 d,T=-6.856,P<0.001).All patients used analgesia pumps after operation,the postoperative pain score was 1.56±0.50 points vs 1.91±0.67 points,the score of the NOSES group was lower than that of the traditional laparoscopic group,showing a difference(T=-3.270,P=0.001),and the number of additional analgesic drugs used in the NOSES group was less than that in the traditional laparoscopy group(X~2=3.985,P=0.046).5.No significant differences were showed in postoperative anastomotic leakage(P=0.659),pulmonary infection(P=0.891),urinary retention(P=0.185),abdominal infection(P=1.000)and intestinal obstruction(P=1.000)of the two groups.Anastomotic bleeding,abdominal bleeding and rectovaginal fistula were not found in all patients.There was no significant difference in postoperative anal function score(X~2=2.455,P=0.964)as well as the Anterior Resection Syndrome(X~2=1.691,P=0.429)about the two groups.6.With a median follow-up of 14 months(6~26 months),all patients were followed up until August 31,2019.One patient in the traditional laparoscopic group died at 16months follow-up,none in the NOSES group died,and no local recurrence occurred in all patients.There were 4 cases of distant metastasis in the traditional laparoscopic group and no one was found in the another group,with no statistical difference(X~2=3.347,P=0.067).Conclusions:1.The natural orifice specimen extraction surgery(NOSES)for colorectal cancer which compared with the traditional laparoscopic surgery has the advantages of less pain,earlier time out of bed,light trauma,quick recovery and good cosmetic effect.2.NOSES did not increase the risk of complications,such as anastomotic leakage,pulmonary infection,rectovaginal fistula,etc.There was no significant difference in anal function,tumor recurrence and metastasis comparing with traditional laparoscopic surgery by operative follow-up.3.This study shows that NOSES is safe and effective.As long as the indications are well mastered,NOSES can bring better clinical effects and has many advantages in clinical promotion.However,this project is a retrospective study and there are few patients included.The observation time is still short,and the clinical data is not sufficient.More comprehensive and valuable data is needed to further verify and support the clinical effects of NOSES.