Transrectal Natural Orifice Specimen Extraction (NOSE) With Oncological Safety: A Prospective and Randomized Trial
| Autor: | Chuangang Fu, Tao Du, Qixin Jiang, Zhuqing Zhou, Wei Gao, Zhe Zhu, Kaijing Wang, Fang Ji |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Laparoscopic surgery
Natural Orifice Endoscopic Surgery medicine.medical_specialty Visual analogue scale Colorectal cancer medicine.medical_treatment Operative Time Blood Loss Surgical law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications Randomized controlled trial law otorhinolaryngologic diseases medicine Humans Prospective Studies Laparoscopy Survival rate Nose medicine.diagnostic_test business.industry Rectal Neoplasms Postoperative complication Length of Stay medicine.disease Surgery Sigmoid Neoplasms medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology business |
| Zdroj: | The Journal of surgical research. 254 |
| ISSN: | 1095-8673 |
| Popis: | Background In the present paper, we introduce our experience with the novel method during laparoscopic anterior resection of upper rectal or sigmoid colon cancer by transrectal natural orifice specimen extraction (NOSE). Methods A prospective randomized controlled trial was performed from June 2016 to May 2019. Patients with upper rectal or sigmoid colon cancer were randomized in a 1:1 ratio to the NOSE group and the non-NOSE group. Preoperative and postoperative clinical variables were analyzed and compared between groups. Postoperative pain was analyzed utilizing a visual analog scale. Postoperative overall survival was analyzed using a Kaplan–Meier curve. Results A total of 276 patients were enrolled, of whom 254 were randomly divided into the NOSE group (n = 122) and the conventional laparoscopic group (n = 119). NOSE failed in 22 cases, which were converted to transabdominal specimen extraction. Intention-to-treat analysis was performed, and these 22 cases were included in the NOSE group. The incidence of postoperative complications was significantly lower in the NOSE group (11/122, 9%) than in the non-NOSE group (25/119, 21%). The NOSE group had a longer operation time, less blood loss, and a lower postoperative visual analog scale score than the non-NOSE group. The time for intestinal function recovery (ventilation) and the length of hospital stay were significantly longer in the non-NOSE group. The Kaplan–Meier survival curve showed no statistically significant difference in the disease-free survival rate between the NOSE group and the non-NOSE group. Conclusions The novel NOSE method is safe and feasible to use in patients having colorectal cancer. Compared with traditional laparoscopic surgery, the postoperative complication rates of NOSE surgery were lower with an improved short-term clinical recovery. |
| Databáze: | OpenAIRE |
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