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  • NCT-501 br Background Low anterior resections are

    2019-10-12


    Background: Low anterior resections are increasingly performed laparoscopically for rectal cancer. Recently, natural orifice specimen extraction surgery (NOSES) has been reported as an alternative approach without additional incisions or extensions. In this study, we aimed to evaluate the safety and feasibility of NOSES by comparing the short-term outcomes with those of conventional laparoscopic resection (CLR) in a multicenter retrospective study from China and Russia.
    Methods: The retrospective multicenter study was conducted at three centers between January 2015 and December 2017. Relevant collected data included patient demographics, operative parameters, and postoperative complications. All NCT-501 procedures were performed using either a NOSES or a CLR approach.
    Results: The data of a total of 768 consecutive patients with rectal cancer were retrospec-tively analyzed, including 412 CLR and 356 NOSES cases. The two groups were comparable
    for all demographics and characteristics except for the median tumor size (P ¼ 0.038). No difference was found in the operative time and number of retrieved NCT-501 nodes. Intra-operative complications and positive resection margins were nil in both groups. No dif-ference was found in the time to first flatus (P ¼ 0.150), time to first defecation (P ¼ 0.084),
    Presented at the third annual meeting of the Society of Asian Academic Surgeons, Milwaukee, Wisconsin, September 2018, as Plenary presentation.
    ** Corresponding author. Clinic of Colorectal and Minimally Invasive Surgery, Sechenov First Moscow State Medical University, 2-4 Bol-shaya Pirogovskaya street, Moscow 119991, Russia. Tel./fax: þ7 4996860016. *** Corresponding author. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer
    Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Beijing 100021, China. Tel.: þ86
    1 These authors contributed equally to Heterokaryon study.
    length of postoperative hospital stay (P ¼ 0.152), anastomotic leakage (P ¼ 0.377), and intra-abdominal abscess (P ¼ NA). The CLR group but not the NOSES group had incisional hernia or wound infection events, although the difference between groups was not significant (P ¼ 0.253).
    Conclusions: The NOSES procedure is a well-established strategy and may be considered as an alternative procedure to CLR for rectal cancer. However, the long-term benefits of this approach require further evaluation.
    ª 2019 Elsevier Inc. All rights reserved.
    Laparoscopic resection has been widely accepted for the sur-gical management of rectal cancer.1-3 This method has clear advantages over open surgery and is associated with reduced postoperative morbidity rates, including wound-related complications.4 However, the current standard procedure for laparoscopic rectal resection besides several minor trocar in-cisions demands a major incision in the abdominal wall for specimen extraction. The bigger incision leads to greater possibility of surgical site infection and incisional hernia.5-8
    Recently, natural orifice specimen extraction surgery (NOSES) has been reported as an alternative approach without a requirement for any additional incisions or extensions.9,10 The transanal or transvaginal routes are viable natural methods for removal of the rectal specimens.11,12 In previous studies, the approach had the potential to decrease post-operative pain, hernia, and especially infection.13-15 However, these results were limited to a restricted number of patients in a single facility, and the technical safety of the procedure remained to be determined. We hypothesized that NOSES could be safe and efficacious in the treatment of patients with rectal cancer and reduce the wound-related complications.