Preliminary Study Of The Application Of Natural Orifice(Vagina) Specimen Extraction Surgery For Total Laparoscopic Radical Gastrectomy

ObjectiveThis study aims to investigate the safety,feasibility and short-term efficacy of total laparoscopic radical gastrectomy with natural orifice(vagina)specimen extraction.Methods1.Patients underwent laparoscopic total gastrectomy with transvaginal specimen extraction(GC-NOSES Ⅷ type)admitted in our hospital from October 2018 to October 2020 were retrospectively recruited for analyzing their clinical data.In addition,relevant literatures were searched in the CNKI,Wanfang,Pubmed,Embase and Sinomad databases published before October 2020 using the following key words:(transvaginal or transanal or transrectal)and(gastric or stomach)and(resection or resections or gastrectomy)and(total or subtotal).The patients underwent laparoscopic total gastrectomy with transvaginal specimen extraction were recruited.Their clinical data were analyzed for exploring the development status and surgical methods at home and abroad of laparoscopic total gastrectomy with transvaginal specimen extraction.2.Differences in clinical data of patients receiving laparoscopic total gastrectomy and those treated with Natural orifice specimen extraction surgery(NOSES)were compared in the matched case-control study(1:1),aiming to compare the safety and short-term efficacy between the two surgical procedures in the treatment of gastric cancer.Results1.All of 3 patients were successfully operated with total laparoscopic radical gastrectomy and the specimens were extracted from the vagina.None of them were transferred to open surgery.The median time of surgery,intraoperative blood loss,number of lymph nodes obtained after operation,time of postoperative exhaust,and postoperative length of stay were 170(120-300)min,100(50-200)ml,39(28-50),3(3-4)d,and 10(7-15)d,respectively.Classified by tumor staging,there were 1 stageⅢ B and 2 stage Ⅱ A cases.Only 1 patient reported postoperative vaginal bleeding,and cured by oral medication of Yunnan Baiyao after 1 week.None of them reported obvious pain on the 2nd day postoperatively.A total of 67 patients were included in the study,including 9 male patients(13.4%),23 female patients(34.3%),and 35 patients with unknown gender.A total of 15 patients(22.4%)received specimens via vagina,3 patients(4.5%)received specimens via anus,14 patients(20.9%)received specimens via mouth,and 35 patients had unknown methods of specimens extraction.Most of the patients underwent subtotal gastrectomy,and total gastrectomy was performed in only 8 patients(11.9%).There are a variety of surgical reconstruction methods of digestive tract.Among the data with clear surgical data,the average number of lymph nodes obtained after surgery was 29.3,the average operative time was 245.8min,the average intraoperative blood loss was 80.2 mL,the average postoperative feeding time was 2.0 days,and the average postoperative hospital stay was 7.0 days.Most of the pathological stages were stage I and II(n=30,accounting for 93.8%).Only 2 patients’pathological stages were stage Ⅲ.Postoperative complications occurred in only 4 patients(6.0%).2.There were 14 patients in total laparoscopic radical gastrectomy group while 14 in NOSES group were compared in the matched case-control study(1:1).No significant differences in the age,body mass index,preoperative complications,lymph node dissection methods,intraoperative complications,intraoperative blood loss,tumor resection margin,tumor size,number of lymph nodes sent for inspection,number of metastatic lymph nodes,pTNM staging,and total complication rate were detected between groups(P>0.05).There were significant differences in the time of surgery(185.0±45.4 min vs 161.1±34.4 min),off-bed time(2.5±1.8 d vs 3.9±1.8 d),time of postoperative exhaust(2.0±2.4 d vs 3.3±1.5 d),time of first meal postoperatively(2.8±2.8 d vs 3.7±2.0 d),and postoperative length of stay(7.0±3.9 d vs 10.1±4.1 d)between total laparoscopic radical gastrectomy group and NOSES group(P<0.05).ConclusionsOur results show that gastric cancer with NOSES is feasible,which is featured as cosmetic demand,quick recovery for off-bed activities and gastrointestinal function,and shortened length of stay.The safety,feasibility and short-term efficacy of NOSES for total laparoscopic radical gastrectomy requires for further analyses.