Propensity Score Matching-based Analysis Of Short-term Outcomes Of Laparoscopic-assisted Natural Orifice Specimen Extraction For Left Colorectal Cancer Radical Resection

Objective To explore short-term results obtained with Laparoscopic-assisted Natural Orifice Specimen Extraction for left colorectal cancer radical resection.Methods 123 patients with left colorectal tumor who had undergone laparoscopic surgery between Jan.2014 and Jun.2015 were reviewed. According to surgical approach, transanal specimen extraction using the Cai Tube(study group, n=29) and trans-abdominal incision specimen extraction(control group, n=123) were studied. Propensity score matching was applied at a ratio of 1:1 comparing the study(n = 23) and control(n = 23) groups.Results The two matched groups had similar baseline characteristics. There was no significant difference in the length of distal or proximal resection margin, the rate of circumferential resection negative margin, the estimated blood loss, the levels of C-reactive protein on 2nd day after surgery, the postoperative time to take solid, the postoperative hospital day, the hospital fee and the postoperative anal function. The study group presented longer operative time[(237.78±68.14)min vs.(168.87±47.49)min,P<0.05], less number of lymph nodes dissected[(12.39±5.42)vs.( 16.39±7.19), P < 0.05], higher white cell count on 2nd day after surgery[( 11.67±3.36) 109/L vs.( 9.35±2.56) 109/L, P < 0.05],but quicker postoperative recovery of bowel function[(2.57±0.73)d vs.(3.41±0.67)d,P<0.05], shorter postoperative ambulation time[(2.30±0.56)d vs.(3.61±0.72)d,P<0.05],lower rate of postoperative complications [(0/23)vs.(6/23),P<0.05] and lower rate of utilization of painkillers in addition to postoperative analgesia pump[(0/20)vs.(9/23),P<0.05].Conclusion Laparoscopic-assisted left colorectal cancer radical resection using the Cai Tube is in line with oncologic principle, less pain, quicker recovery and better cosmetic results.