Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2019; 7(2): 122-129
Published online Jan 26, 2019. doi: 10.12998/wjcc.v7.i2.122
Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer
Jun-Hong Hu, Xing-Wang Li, Chen-Yu Wang, Jun-Jie Zhang, Zheng Ge, Bing-Hui Li, Xu-Hong Lin
Jun-Hong Hu, Xing-Wang Li, Chen-Yu Wang, Jun-Jie Zhang, Zheng Ge, Bing-Hui Li, Department of Anorectal Surgery, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
Bing-Hui Li, Evidence-Based Medicine Center, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
Xu-Hong Lin, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
Author contributions: Hu JH and Li XW contributed equally to this work; Lin XH and Hu JH designed the research; Li XW, Wang CY, Zhang JJ, and Ge Z performed the research; Li BH and Lin XH analyzed the data; Lin XH, Li XW, and Hu JH wrote the paper.
Supported by National Natural Science Foundation of China, No. 81500430 and No. U1304802 (to Lin XH); Basic and Frontier Technology Research Program of Henan Province, No. 162300410101 (to Hu JH); Wu Jieping Medical Foundation of Clinical Research Special Fund, No. 320.2710.1836 (to Hu JH); and The Henan Science and Technology Planning Project, No. 182102310544 (to Lin XH).
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Huaihe Hospital Affiliated to Henan University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xu-Hong Lin, MD, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital Affiliated to Henan University, 115 Ximen Street, Kaifeng 475000, Henan Province, China. 800726lxh@tongji.edu.cn
Telephone: +86-371-23906958 Fax: +86-371-23906058
Received: October 19, 2018
Peer-review started: October 19, 2018
First decision: November 27, 2018
Revised: December 18, 2018
Accepted: January 3, 2019
Article in press: January 3, 2019
Published online: January 26, 2019
Abstract
BACKGROUND

This case-control study compared the short-term clinical efficacy of natural orifice specimen extraction surgery (NOSES) using a prolapsing technique and the conventional laparoscopic-assisted approach for low rectal cancer.

AIM

To further explore the application value of the transanal placement of the anvil and to evaluate the short-term efficacy of NOSES for resecting specimens of low rectal cancer, as well as to provide a theoretical basis for its extensive clinical application.

METHODS

From June 2015 to June 2018, 108 consecutive laparoscopic-assisted low rectal cancer resections were performed at our center. Among them, 26 specimens were resected transanally using a prolapsing technique (NOSES), and 82 specimens were resected through a conventional abdominal wall small incision (LAP). A propensity score matching method was used to select 26 pairs of matched patients, and their perioperative data were analyzed.

RESULTS

The baseline data were comparable between the two matched groups. All 52 patients underwent the surgery successfully. The operative time, blood loss, number of harvested lymph nodes, postoperative complication rate, circumferential margin involvement, postoperative follow-up data, and postoperative anal function were not statistically significant. The NOSES group had shorter time to gastrointestinal function recovery (2.6 ± 1.0 d vs 3.4 ± 0.9 d, P = 0.006), shorter postoperative hospital stay (7.1 ± 1.7 d vs 8.3 ± 1.1 d, P = 0.003), lower pain score (day 1: 2.7 ± 1.8 vs 4.6 ± 1.9, day 3: 2.0 ± 1.1 vs 4.1 ± 1.2, day 5: 1.7 ± 0.9 vs 3.3 ± 1.0, P < 0.001), a lower rate of additional analgesic use (11.5% vs 61.5%, P = 0.001), and a higher satisfaction rate in terms of the aesthetic appearance of the abdominal wall after surgery (100% vs 23.1%, P < 0.001).

CONCLUSION

NOSES for low rectal cancer can achieve satisfactory short-term efficacy and has advantages in reducing postoperative pain, shortening the length of postoperative hospital stay, and improving patients’ satisfaction in terms of a more aesthetic appearance of the abdominal wall.

Keywords: Natural orifice specimen extraction surgery, Low rectal cancer, Laparoscopy, Prolapsing technique, No auxiliary incision

Core tip: The efficacy and safety of natural orifice specimen extraction surgery (NOSES) for low rectal cancer using a prolapsing technique remain unclear. To reduce selection bias, a propensity score matching was introduced to achieve a comparison between the NOSES and laparoscopic groups.