Clinical Efficacy Of Transvaginal Specimen Retrieval Under ERAS Concept In 3D Laparoscopic Radical Surgery For Rectal Cancer

Purpose:Enhanced recovery after surgery(ERAS)and natural orifice specimen extraction surgery(NOSES)are research hotspots in the field of rectal cancer surgery in recent years.Both are further developments of the minimally invasive concept based on laparoscopic radical resection of rectal cancer.The aim of this study is to investigate the safety and clinical efficacy of transvaginal specimen extraction in 3D laparoscopic radical rectal cancer surgery compared with conventional transabdominal adjuvant incision under the concept of ERAS.Method:The clinical data of female patients undergoing 3D laparoscopic radical resection of rectal cancer based on ERAS from January 2018 to December 2022 at Henan University People’s Hospital were retrospectively analyzed.According to the different ways of extracting specimens,they were divided into a vaginal specimen extraction group(NOSES group)with 48 cases and an abdominal auxiliary incision group(conventional group)with 83 cases.Propensity score matching(PSM)was used to match the general data of the two groups of patients,and the intraoperative,postoperative and follow-up data of successfully matched patients were compared and analyzed.The perioperative related indicators,postoperative complication rate and tumor radical indicators of the two groups of patients were compared.The pelvic floor function was evaluated using the Pelvic Floor Distress Inventory-short form20(PFDI-20)before surgery and at 6 months after surgery.The time for postoperative recovery of sexual life in the two groups was followed up and the Female Sexual Function Index(FSFI)scoring scale was used to evaluate the preoperative and postoperative sexual life quality of patients.Follow up and record the recurrence and metastasis of the two groups of patients.Result:Before PSM,there was a statistical difference in BMI between the two groups(P=0.003).To exclude confounding factors between the groups,the general information of the two groups was PSM and a total of76(38 pairs)patients were successfully matched.After PSM,there was no statistical difference between the two groups in terms of general clinical data such as age,BMI,ASA classification and preoperative T-stage(all P > 0.05),which led to further statistical analysis of the intraoperative and postoperative data between the two groups.Compared with the conventional group,the NOSES group had a shorter postoperative exhaust time [(45.00±10.70)h vs.(50.37±12.04)h,P=0.043],a lower rate of additional analgesia use [21.1%vs.52.6%,P=0.004],and lower VAS scores on postoperative day 1 [4(2)vs.5(2),P<0.001],day 3 [3(1)vs.3(1),P=0.008],and day 5 [1(1)vs.2(1),P=0.002].The abdominal cosmetic satisfaction was higher[(7.50±1.33)vs.(6.13±1.58),P<0.001] and the incidence of incision-related complications was lower [0.00%vs.10.5%,P=0.012].There was no statistical difference in other perioperative indicators such as operation time,intraoperative bleeding,hospitalization time,and hospitalization expenses between the two groups(all P>0.05).The proximal margin lengths(distance from proximal margin to upper edge of tumor)of the two groups were(11.47±0.89)cm and(11.68±0.93)cm,respectively;the distal margin lengths(distance from distal margin to lower edge of tumor)were(2.67±0.38)cm and(2.70±0.39)cm,respectively;and no cases with positive margins were found.There was no significant difference in postoperative pathology between the two groups(all P>0.05).The PFDI-20 scores of both groups increased at 6 months after surgery[(19.63±4.41)points vs.(21.79±4.43)points,P<0.001],[(20.58±5.02)points vs.(23.16±5.08)points,P<0.001],but there was no statistical significance in the comparison of preoperative PFDI-20 scores and 6-month postoperative PFDI-20 scores between the two groups(all P>0.05).A total of 16 patients in both groups had sexual life before and after surgery,and the NOSES group recovered faster after surgery[(5.56±1.24)months vs.(8.71±1.80)months,P=0.001].The FSFI scores of both groups decreased after surgery compared to before surgery [(20.42±2.24)points vs.(19.06±2.80)points,P=0.005],[(20.70±2.52)points vs.(19.40±2.84)points,P=0.002],but there was no statistical significance in the comparison of preoperative FSFI scores and postoperative FSFI scores between the two groups(all P>0.05).As of December 2022,the median follow-up time for both groups was 26 months,with a total of 7 patients experiencing recurrence and metastasis,and no deaths occurred.There was no statistical difference in the comparison of recurrence and metastasis rates and tumor-free survival rates between the two groups(all P>0.05).Conclusion:Under the ERAS concept,transvaginal specimen extraction 3D laparoscopic radical resection of rectal cancer has the advantages of light postoperative pain,fast recovery of gastrointestinal function,high abdominal cosmetic satisfaction,and early recovery of sexual function.The clinical effect is significant.It also meets the requirements of sterility and tumor-free to a certain extent,has a good tumor radical effect,and is highly safe.Therefore,transvaginal specimen extraction has important significance in the clinical practice of accelerated recovery surgery.