Preliminary surgical outcomes of laparoscopic right hemicolectomy with transrectal specimen extraction: a propensity score matching study of 120 cases (with video)

Abstract

Background: Compared with conventional laparoscopic surgery, natural orifice specimen extraction surgery (NOSES) has many advantages. Laparoscopic right colectomy with transvaginal specimen extraction has been reported, but the safety and feasibility of transrectal specimen extraction in male patients with ascending colon cancer remain to be verified. This study aimed to preliminarily evaluate the feasibility and safety of laparoscopic right hemicolectomy with transrectal specimen extraction.

Methods: The study was conducted at a single tertiary medical center in China. A total of 494 consecutive patients who underwent laparoscopic right colectomy between September 2018 and September 2020 were included. Transrectal specimen extraction was performed in 40 male patients (the NOSES group). Patients in the NOSES group were matched to the conventional laparoscopic group using propensity score matching at a 1:2 ratio. Short-term and long-term outcomes between the two groups were compared and evaluated.

Results: Forty patients in the NOSES group and 80 patients in the conventional laparoscopic group were matched for analysis. Baseline characteristics were balanced after propensity matching. The operative features, including operating time, intraoperative bleeding, and the number of harvested lymph nodes, were statistically comparable in both groups. In terms of post-operative recovery, patients in the NOSES group showed preferable outcomes, as evidenced by less post-operative pain and faster return to flatus, defecation, and discharge. The post-operative complications rate, according to the Clavien-Dindo classification system, was similar in both groups. No differences in overall survival or disease-free survival were observed between the two groups.

Conclusions: Laparoscopic right colectomy with transrectal specimen extraction is oncologically safe. Compared with conventional laparoscopic right colectomy, it can reduce post-operative pain, accelerate post-operative recovery, shorten the hospital stay, and achieve better cosmetic effect.

Keywords: laparoscopic right colectomy; natural orifice specimen extraction surgery; transrectal specimen extraction.

Figure 1.

Flowchart of patient selection

Figure 2.

Procedures of transrectal specimen extraction. (A) The specimen is placed into the sterile protective sleeve. (B) A longitudinal incision is made on the anterior of wall of the upper rectum. (C) and (D) The oval forceps is applied to pull the specimen along with the protective sleeve out through the incision in the upper rectum. (E) The full-layer running suturing is performed to close the incision. (F) Colonoscopy examination is conducted to confirm that there is no leakage and striction on the site of suturing.

Figure 3.

Kaplan–Meier analysis for comparison of overall survival and disease-free survival of patients in the NOSES group and the laparoscopic group. (A) Comparison of disease-free survival between the NOSES group and the laparoscopic group. (B) Comparison of overall survival between NOSES group and laparoscopic group.