Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2024 Sep 6;22(1):237.
doi: 10.1186/s12957-024-03513-3.

Short-term outcomes of Transrectal Natural Orifice Specimen extraction compared with conventional minimally invasive surgery for selected patients with colorectal cancer: a propensity score matching analysis and literature review

Li-Yang Chan  1 , Yih-Jong Chern  1 , Yu-Jen Hsu  1 , Bor-Kang Jong  1 , I-Li Lai  1 , Pao-Shiu Hsieh  1 , Chun-Kai Liao  1 , Jeng-Fu You  2
Affiliations
Comparative Study

Short-term outcomes of Transrectal Natural Orifice Specimen extraction compared with conventional minimally invasive surgery for selected patients with colorectal cancer: a propensity score matching analysis and literature review

Li-Yang Chan et al. World J Surg Oncol. .

Abstract

Purpose: Conventional minimally invasive surgery requires mini-laparotomy to extract the pathological specimen. However, by using a natural orifice as the delivery route, natural orifice specimen extraction (NOSE) surgery avoids the need for a large incision. This study analyzed the short-term outcome of NOSE compared with conventional mini-laparotomy (CL) for colorectal cancer surgery.

Methods: We conducted a retrospective analysis of 1,189 patients who underwent surgery for primary colorectal cancer between the cecum and upper rectum. Propensity score analyses were applied to the NOSE and CL groups in a 1:1 matched cohort.

Results: After propensity score matching, each group included 201 patients. The NOSE group and CL group did not differ significantly in terms of baseline characteristics. Postoperative morbidity and mortality rates were comparable. Compared with the CL group, the NOSE group experienced a shorter time to first flatus (1.6 ± 0.8 vs. 2.0 ± 1.2 days, p < 0.001), first stool (2.7 ± 1.5 vs. 4.1 ± 1.9, p < 0.001), liquid diet (2.3 ± 1.3 vs. 3.6 ± 1.8 days, p < 0.001), soft diet (3.9 ± 2.0 vs. 5.2 ± 1.9 days, p < 0.001) and a shorter hospital stay (5.1 ± 3.5 vs. 7.4 ± 4.8 days, p < 0.001). The NOSE group exhibited lower mean pain intensity and lower highest pain intensity on postoperative days 1, 2, and 3.

Conclusion: NOSE has several advantages over conventional mini-laparotomy following minimally invasive surgery for colon cancer. These advantages include reduced time to oral intake, shorter hospital stays, and less postoperative pain. NOSE can be adopted and applied to highly selective patients without additional risk of short-term complications.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study design. This flowchart illustrates the inclusion and exclusion criteria for the study, along with the final number of patients in the NOSE and CL groups
Fig. 2
Fig. 2
Critical steps of NOSE
Fig. 3
Fig. 3
Love plot illustrating patient characteristics before and after propensity score matching
Fig. 4
Fig. 4
Development of mean pain intensity (a) and highest pain intensity (b) on postoperative day. Values are presented as mean ± standard deviation. NRS = numeric rating scale; POD = postoperative day
Fig. 5
Fig. 5
Percentage of patients who received only enteral analgesics on postoperative day 1–3
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin May. 2021;71(3):209–49.10.3322/caac.21660 - DOI - PubMed
    1. Lacy AM, García-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet Jun. 2002;29(9325):2224–9.10.1016/S0140-6736(02)09290-5 - DOI - PubMed
    1. Nelson H, Sargent DJ, Wieand HS, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med May. 2004;13(20):2050–9. - PubMed
    1. Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol Jul. 2007;20(21):3061–8.10.1200/JCO.2006.09.7758 - DOI - PubMed
    1. van der Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol Mar. 2013;14(3):210–8.10.1016/S1470-2045(13)70016-0 - DOI - PubMed

Publication types

LinkOut - more resources