Outcomes after natural orifice extraction vs conventional specimen extraction surgery for colorectal cancer: A propensity score-matched analysis

Table 1 Patient and surgical characteristics for patients who underwent 3-port laparoscopic colorectal surgery with natural orifice specimen extraction

Patient	Age	ASA	Sex	BMI (kg/m2)	Surgery	Indication
1	80	3	F	29.1	Anterior resection, transvaginal NOSE	Sigmoid cancer pT3N1M0
2	59	1	F	20.0	Left hemicolectomy, transvaginal NOSE	Splenic flexure cancer pT3N1M0
3	82	3	F	22.4	Anterior resection, transvaginal NOSE	Sigmoid cancer pT3N0M0
4	43	2	F	31.7	Anterior resection, transanal NOSE	Sigmoid cancer pT1N0M0
5	78	3	F	21.6	Right hemicolectomy (D3), transvaginal NOSE	Transverse colon cancer pT3N1M0
6	63	2	F	28.0	Right hemicolectomy (D3), transvaginal NOSE	Hepatic flexure cancer pT1N0M0
7	77	2	M	20.3	Anterior resection with DI, transanal NOSE	Mid rectal cancer pT3N1M0
8	50	2	F	28.0	Anterior resection, transvaginal NOSE	Sigmoid cancer pT3N0M0
9	77	2	M	24.3	Anterior resection with DI, transanal NOSE	Mid rectal cancer pT3N1M0
10	79	3	M	24.3	Anterior resection, transanal NOSE	Upper rectal cancer pT3N1M0
11	73	3	M	22.4	Anterior resection, transanal NOSE	Sigmoid cancer pT4N2M1
12	58	2	F	23.5	Anterior resection, transvaginal NOSE	Sigmoid cancer pT2N0M0
13	67	2	M	27.6	Anterior resection, transanal NOSE	Sigmoid cancer pT2N1M0
14	58	2	F	23.8	Left hemicolectomy, transvaginal NOSE	Splenic flexure cancer pT1N0M0

ASA: American Society of Anesthesiologists score; BMI: Body mass index; M: Male; F: Female; NOSE: Natural orifice specimen extraction; DI: Defunctioning ileostomy.

Table 2 Intraoperative data and postoperative outcomes for patients who underwent 3-port laparoscopic colorectal surgery with natural orifice specimen extraction

Patient	Operative time (min)	Blood loss (mL)	Time to first flatus/ BO (da)	Postoperative LOS (da)	Postoperative complications
1	235	30	1/1	4	Nil
2	170	20	1/2	3	Nil
3	210	30	2/2	3	Nil
4	200	20	1/1	3	Nil
5	260	100	2/1	3	Nil
6	255	50	2/2	5	Chylous ascites
7	265	80	1/1	3	Nil
8	175	10	1/1	3	Nil
9	300	150	1/1	6	High stoma output
10	365	100	1/1	3	Nil
11	205	20	1/2	3	Nil
12	155	30	1/2	2	Nil
13	205	10	2/2	3	Nil
14	180	50	1/2	3	Nil

^aPostoperative days. BO: Bowel opening; LOS: Length of stay.

Table 3 Comparison of characteristics between laparoscopic 3-port colorectal natural orifice specimen extraction surgery with a propensity score-matched cohort of conventional surgery

Characteristic	NOSE, n = 14 Frequency (%)	Non-NOSE, n = 56 Frequency (%)	P value
Age, mean ± SD (yr)	67.4 ± 12.4	73.1 ± 10.2	0.182
Gender
Male	5 (35.7)	21 (37.5)	0.765
Female	9 (64.3)	35 (62.5)
BMI, mean ± SD (kg/m2)	24.8 ± 3.5	24.0 ± 4.1	0.526
ASA score
1	1 (7.1)	1 (1.8)	0.265
2	8 (57.1)	43 (76.8)
3	5 (35.7)	12 (21.4)
Tumor location
Caecum to transverse colon	2 (14.3)	18 (32.1)	0.219
Splenic flexure to sigmoid	9 (64.3)	22 (39.3)
Rectum	3 (21.4)	16 (28.6)
Surgery
Anterior resection	7 (50.0)	23 (41.1)	0.576
Low anterior resection	3 (21.4)	13 (23.2)
Left hemicolectomy	2 (14.3)	3 (5.4)
Right hemicolectomy	2 (14.3)	17 (30.4)
Defunctioning stoma creation
Yes	3 (21.4)	9 (16.1)	0.634
No	11 (78.6)	47 (83.9)
AJCC pT stage
T1	4 (28.6)	7 (12.5)	0.527
T2	2 (14.3)	10 (17.9)
T3	7 (50)	33 (58.9)
T4	1 (7.1)	6 (10.7)
AJCC pN stage
N0	6 (42.9)	33 (58.9)	0.236
N1	7 (50.0)	15 (26.8)
N2	1 (7.1)	8 (14.3)
M stage
M0	13 (92.9)	55 (98.2)	0.282
M1	1 (7.1)	1 (1.8)
Stage
I	4 (28.6)	13 (23.2)	0.162
II	1 (7.1)	20 (35.7)
III	8 (57.1)	22 (39.3)
IV	1 (7.1)	1 (1.8)

NOSE: Natural orifice specimen extraction; ASA: American Society of Anesthesiologists score; BMI: Body mass index; SD: Standard deviation, AJCC: American Joint Committee on Cancer Staging 8^th Edition.

Table 4 Comparison of perioperative outcomes between laparoscopic 3-port colorectal natural orifice specimen extraction surgery with a propensity score-matched cohort of conventional surgery

Outcome	NOSE n = 14 Frequency (%)	Non-NOSE n = 56 Frequency (%)	P value
Duration of surgery, mean ± SD (min)	227 ± 55	261 ± 96	0.463
Intraoperative complications
Yes	0 (0)	2 (3.6)	0.473
No	14 (100)	54 (96.4)
30-day postoperative complications
Yes	2 (14.3)	13 (23.2)	0.466
No	12 (85.7)	43 (76.8)
Clavien-Dindo classification			0.202
1	1 (7.1)	5 (8.9)
2	1 (7.1)	7 (12.5)
3	0	0
4	0	1 (1.8)
5	0	0
Time to first bowel movement, mean ± SD (d)	1.2 ± 0.4	2.6 ± 2.0	<0.001
Length of hospitalization stay, mean ± SD (d)	3.4 ± 1.0	6.4 ± 5.3	<0.001
POD 1 highest pain scorea, mean ± SD	1.5 ± 1.9	3.0 ± 2.0	0.012
POD 2 highest pain scorea, mean ± SD	0.7 ± 1.5	1.8 ± 2.2	0.066
POD 1 PCA total morphine use, mean ± SD (mg)	1.4 ± 3.3	6.7 ± 8.1	0.002
POD 2 PCA total morphine use, mean ± SD (mg)	0	2.5 ± 5.1	0.005

^aMeasured using visual analog scale. NOSE: Natural orifice specimen extraction; SD: Standard deviation; POD: Postoperative day; PCA: Patient-controlled analgesia.