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腹腔镜下前切除术治疗结直肠癌后,采用常规微创剖腹手术经肛门自然孔板标本提取的短期疗效和生存结果比较
Authors Zhou S, Wang X, Zhao C, Pei W, Zhou H, Liu Q, Liang J, Zhou Z, Wang X
Received 18 March 2019
Accepted for publication 4 June 2019
Published 1 July 2019 Volume 2019:11 Pages 5939—5948
DOI https://doi.org/10.2147/CMAR.S209194
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 3
Editor who approved publication: Professor Bilikere Dwarakanath
Background: Transanal natural orifice specimen extraction (NOSE) in colorectal surgery has been introduced as a less invasive surgery. However, its long-term survival effects remain controversial. The aim of this study was to compare the short-term and long-term survival outcomes of transanal NOSE with those of the conventional laparoscopic approach with mini-laparotomy (LAP) for anastomosis construction and specimen extraction in sigmoid colon cancer or rectal cancer.
Methods: From January 2007 to January 2018, a retrospective study was conducted at the China National Cancer Center. In total, 52 consecutive patients who underwent laparoscopic anterior resection with NOSE were matched with an additional 52 patients who underwent conventional LAP for colorectal cancer.
Results: Patients in the NOSE group experienced shorter time to passage of flatus (2.8±0.8 vs 3.2±0.9 days; p =0.042), less pain (4.2±1.4 vs 5.4±1.7; p =0.003) and less analgesia required (7.7% vs 25.0%; p =0.032). After a median follow-up of 68.5 (range, 8–83) months, the two groups had similar 5-year overall survival rates (92.3% vs 94.2%; p =0.985) and disease-free survival rates (84.6% vs 86.5%; p =0.802).
Conclusion: Transanal NOSE for total laparoscopic anterior resection is safe and feasible with more advantages, including lower pain, lower tissue trauma and faster recovery of intestinal function. Moreover, with proper protection of the surgical route, transanal NOSE has the same long-term outcomes as conventional laparoscopic surgery.
Keywords: natural orifice specimen extraction, transanal specimen extraction, total laparoscopic resection, sigmoid colon cancer, rectal cancer, surgical outcomes