Safety and clinical efficacy analysis of three<b>-</b>dimensional complete laparoscopic radical rectal cancer resection using natural orifice specimen extraction surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Guangyi ¹ , LI Yang ¹ , WANG Huan ² ,  XU Guoqiong ²

1. Department of Gastroenteranorectal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;
2. Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

XU Guoqiong, Email: 1972024268@qq.com

Keywords：

three-dimensional laparoscopic; radical rectal cancer resection; natural orifice specimen extraction surgery; clinical efficacy; safety

DOI：

10.7507/1007-9424.202209083

Video：

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Objective To evaluate the safety, functional protection, and clinical efficacy of three-dimensional (3D) complete laparoscopic radical rectal cancer resection using natural orifice specimen extraction surgery (NOSES). Methods According to the inclusion and exclusion criteria, the patients who received laparoscopic radical rectal cancer surgery in the Second Affiliated Hospital of Chongqing Medical University from January 2019 to December 2020 were retrospectively collected. The patients underwent 3D complete laparoscopic radical rectal cancer resection using NOSES were allocated to the observation group, while traditional laparoscopic assisted radical rectal cancer resection were allocated to the control group. The indexes of safety, functional protection, and clinical efficacy were compared between the two groups. Results A total of 80 patients were included in this study, including 40 patients in the observation group and 40 patients in the control group. There were no statistical differences in the baseline data between the two groups (P>0.05). There were no statistical differences between the two groups in the total operative time, intraoperative bleeding, number of lymph node dissection, positive rates of intraperitoneal tumor cells and bacterial culture, and tumor recurrence and metastasis rate (P>0.05). Compared with the control group, the first getting out of bed time, exhausting and defecating time after operation were earlier, meanwhile the postoperative pain score, use of analgesics, and the occurrence of severe low anterior resection syndrome were better in the observation group (P<0.05). The incidence of postoperative overall complications in the observation group was lower than that in the control group (P<0.01). The postoperative hospital stay was shorter and the hospitalization costs were less in the observation group as compared with the control group (P<0.05). Conclusion From results of this study, 3D complete laparoscopic radical rectal cancer resection using NOSES is safe and feasible, its functional protection and clinical efficacy are better than those of traditional laparoscopic assisted radical rectal cancer resection.

Citation： LIU Guangyi, LI Yang, WANG Huan, XU Guoqiong. Safety and clinical efficacy analysis of three-dimensional complete laparoscopic radical rectal cancer resection using natural orifice specimen extraction surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(3): 290-295. doi: 10.7507/1007-9424.202209083 Copy

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, 2021, 71(3): 209-249.
2.	Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
3.	王锡山. 结直肠肿瘤治疗的微创和功能外科理念在实践与探索中前行. 中华结直肠疾病电子杂志, 2013, 2(3): 106-108.
4.	张焕标, 俞金龙, 崔春晖. 经自然腔道取出标本手术联合加速康复理念在结直肠癌治疗中的应用. 中华胃肠外科杂志, 2016, 19(12): 1419-1421.
5.	Storz P, Buess GF, Kunert W, et al. 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc, 2012, 26(5): 1454-1460.
6.	中华人民共和国国家卫生健康委员会医政医管局, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范(2020年版). 中国实用外科杂志, 2020, 40(6): 601-625.
7.	Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11: S240-S252. doi: 10.1002/acr.20543.
8.	王一琳, 黄明君, 熊方丽, 等. 直肠癌患者术后LARS发生程度对生活质量影响的meta分析. 中国普外基础与临床杂志, 2022, 29(2): 179-187.
9.	Nikai H, Koyama M, Morohashi H, et al. Retrospective study of the usefulness of peritoneal lavage cytology in patients with curative resection for colorectal cancer. J Jap Pract Surg Soc, 2015, 76(3): 466-471.
10.	许万松, 于洪亮, 杨茂鹏, 等. 大肠癌患者术中腹腔冲洗液中Survivin mRNA的检测及临床意义. 临床外科杂志, 2007, 15(5): 333-335.
11.	Ngu J, Wong AS. Transanal natural orifice specimen extraction in colorectal surgery: bacteriological and oncological concerns. ANZ J Surg, 2016, 86(4): 299-302.
12.	Hisada M, Katsumata K, Ishizaki T, et al. Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol, 2014, 20(44): 16707-16713.
13.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
14.	杨政道, 赵栩诗, 姜雪, 等. 结直肠癌NOSES和传统腹腔镜手术的临床对比研究和探讨. 中华腔镜外科杂志(电子版), 2019, 12(4): 226-230.
15.	Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2. 2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(7): 874-901.
16.	Wolthuis AM, Meuleman C, Tomassetti C, et al. How do patients score cosmesis after laparoscopic natural orifice specimen extraction colectomy? Colorectal Dis, 2015, 17(6): 536-541.
17.	Saurabh B, Chang SC, Ke TW, et al. Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection: feasibility, outcomes, and technical considerations. Dis Colon Rectum, 2017, 60(1): 43-50.
18.	杜涛, 傅传刚. 3D腹腔镜下直肠癌根治术中植物神经保护的研究. 中华结直肠疾病电子杂志, 2019, 8(4): 349-352.
19.	王锡山. 结直肠肿瘤类—NOTES术之现状及展望. 中华结直肠疾病电子杂志, 2015, 4(4): 11-16.
20.	Palanivelu C, Rangarajan M, Jategaonkar PA, et al. An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction” (N. O. S. E). Dis Colon Rectum, 2008, 51(7): 1120-1124.
21.	Franklin ME, Liang S, Russek K. Integration of transanal specimen extraction into laparoscopic anterior resection with total mesorectal excision for rectal cancer: a consecutive series of 179 patients. Surg Endosc, 2013, 27(1): 127-132.
22.	中国NOSES联盟, 中国医师协会结直肠肿瘤专业委员会NOSES专委会. 结直肠肿瘤经自然腔道取标本手术专家共识(2017). 中华结直肠疾病电子杂志, 2017, 6(4): 266-272.
23.	朱水根, 汪春良, 朱建军, 等. 腹腔镜直肠癌经肛拖出式切除术可行性分析. 中华普通外科杂志, 2014, 29(3): 216-217.

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, 2021, 71(3): 209-249.
2. Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl), 2021, 134(7): 783-791.
3. 王锡山. 结直肠肿瘤治疗的微创和功能外科理念在实践与探索中前行. 中华结直肠疾病电子杂志, 2013, 2(3): 106-108.
4. 张焕标, 俞金龙, 崔春晖. 经自然腔道取出标本手术联合加速康复理念在结直肠癌治疗中的应用. 中华胃肠外科杂志, 2016, 19(12): 1419-1421.
5. Storz P, Buess GF, Kunert W, et al. 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks. Surg Endosc, 2012, 26(5): 1454-1460.
6. 中华人民共和国国家卫生健康委员会医政医管局, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范(2020年版). 中国实用外科杂志, 2020, 40(6): 601-625.
7. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken), 2011, 63 Suppl 11: S240-S252. doi: 10.1002/acr.20543.
8. 王一琳, 黄明君, 熊方丽, 等. 直肠癌患者术后LARS发生程度对生活质量影响的meta分析. 中国普外基础与临床杂志, 2022, 29(2): 179-187.
9. Nikai H, Koyama M, Morohashi H, et al. Retrospective study of the usefulness of peritoneal lavage cytology in patients with curative resection for colorectal cancer. J Jap Pract Surg Soc, 2015, 76(3): 466-471.
10. 许万松, 于洪亮, 杨茂鹏, 等. 大肠癌患者术中腹腔冲洗液中Survivin mRNA的检测及临床意义. 临床外科杂志, 2007, 15(5): 333-335.
11. Ngu J, Wong AS. Transanal natural orifice specimen extraction in colorectal surgery: bacteriological and oncological concerns. ANZ J Surg, 2016, 86(4): 299-302.
12. Hisada M, Katsumata K, Ishizaki T, et al. Complete laparoscopic resection of the rectum using natural orifice specimen extraction. World J Gastroenterol, 2014, 20(44): 16707-16713.
13. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
14. 杨政道, 赵栩诗, 姜雪, 等. 结直肠癌NOSES和传统腹腔镜手术的临床对比研究和探讨. 中华腔镜外科杂志(电子版), 2019, 12(4): 226-230.
15. Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2. 2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(7): 874-901.
16. Wolthuis AM, Meuleman C, Tomassetti C, et al. How do patients score cosmesis after laparoscopic natural orifice specimen extraction colectomy? Colorectal Dis, 2015, 17(6): 536-541.
17. Saurabh B, Chang SC, Ke TW, et al. Natural orifice specimen extraction with single stapling colorectal anastomosis for laparoscopic anterior resection: feasibility, outcomes, and technical considerations. Dis Colon Rectum, 2017, 60(1): 43-50.
18. 杜涛, 傅传刚. 3D腹腔镜下直肠癌根治术中植物神经保护的研究. 中华结直肠疾病电子杂志, 2019, 8(4): 349-352.
19. 王锡山. 结直肠肿瘤类—NOTES术之现状及展望. 中华结直肠疾病电子杂志, 2015, 4(4): 11-16.
20. Palanivelu C, Rangarajan M, Jategaonkar PA, et al. An innovative technique for colorectal specimen retrieval: a new era of “natural orifice specimen extraction” (N. O. S. E). Dis Colon Rectum, 2008, 51(7): 1120-1124.
21. Franklin ME, Liang S, Russek K. Integration of transanal specimen extraction into laparoscopic anterior resection with total mesorectal excision for rectal cancer: a consecutive series of 179 patients. Surg Endosc, 2013, 27(1): 127-132.
22. 中国NOSES联盟, 中国医师协会结直肠肿瘤专业委员会NOSES专委会. 结直肠肿瘤经自然腔道取标本手术专家共识(2017). 中华结直肠疾病电子杂志, 2017, 6(4): 266-272.
23. 朱水根, 汪春良, 朱建军, 等. 腹腔镜直肠癌经肛拖出式切除术可行性分析. 中华普通外科杂志, 2014, 29(3): 216-217.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Safety and clinical efficacy analysis of three-dimensional complete laparoscopic radical rectal cancer resection using natural orifice specimen extraction surgery

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