| Objective:To compare the clinical outcomes between natural orifice specimen extraction during robotic rectal radical resection and conventional robot-assisted rectal radical resection.Methods:The clinical data of patients undergoing robotic anterior resection for rectal cancer in the First Affiliated Hospital of Nanchang University from January 2017 to February 2020 were retrospectively analyzed.Inclusion criteria:(1)preoperatively definite diagnosis of primary rectal cancer by colonoscopy and biopsy and tumor ≥ 4 cm from margin of anus;(2)tumors were evaluated as T1-T3 tumor by iconography without distant metastasis;(3)The tumor diameter ≤3cm was obtained via the rectum,and the tumor diameter ≤5 through the vagina;(4)robotic radical resection of rectal cancer;(5)the clinical and pathological data were complete.74 patients(NOSES group)were selected to undergo robotic anterior resection with natural orifice specimen extraction,Another 1: 1 pairing was performed,and 74 patients with rectal cancer who were consistent with the tumor age(±2),BMI,ASA,location,gender,and tumor stage of the NOSES group during the same period(with a difference in operation time of ≤6 months)were selected to form the traditional control group.Analyze and compare the perioperative period,pathology of surgical specimens and recent oncology results of the two groups.Results:There was no significant difference in gender,age,BMI,tumor location,ASA classification,tumor T stage and other baseline data between the two groups(all P> 0.05).compared to traditional control group,the NOSES group presented faster time to first flatus [(41.3±12.8)hours vs.(51.6±8.9)hours,P<0.05],the first time of postoperative fluid intake was earlier [(46.9±10.4)hours vs.(57.5±10.3)hours,P<0.05] and lower pain score at the first postoperative day,second postoperative day and third postoperative day [(4.3±1.3)vs.(5.1±1.6),P<0.05;(2.3±1.1)vs.(3.8±1.1),P<0.05;(1.6±0.8)vs.(2.1±1.2),P<0.05;],the case ratio of additional analgesia was lower[8.1%(6/74)vs.25.6%(19/74),P<0.05].Self-assessed monitoring established that patients in the NOSES group experienced significantly better cosmetic results(cosmetic score 8.2±1.4 vs.6.5±1.2,P<0.05).Meanwhile,the number of endoscopic linear staplers used for rectal transection in the traditional control group was significantly more than that in the NOSES group [(1.2±0.3)vs.(1.4±0.5),P<0.05].There were no significant differences in terms of surgical procedures,operation time,blood loss,postoperative hospital stay,the hospital cost and perioperative secondary surgery.The postoperative complication rate was lower in NOSES group(12.1%)compared to traditional control group(17.6%),but there was no statistical significance.Tumor size,proximal resection margin,distal resection margin,number of lymph node dissections,number of positive lymph nodes,the differentiation of tumors,TNM staging,nerve invasion,vascular invasion,and lymphatic invasion,were similar between the groups.The median follow-up period was 25(range,1–37)months,the 2-year overall survival(94.3% vs.95.4%,P=0.739)and 2-year disease-free survival(96.1% vs.95.2%,P=0.952)were all comparable between the two groups.Conclusion:Robotic anterior resection with natural orifice specimen extraction for rectal cancer is safe and feasible with more advantages,including lower pain,lower analgesia requirements,faster recovery of intestinal function,excellent cosmetic results.Moreover,it can achieve comparable oncological outcomes to conventional robot-assisted procedure.So,It has good application value and prospect in the treatment of rectal cancer,and is worthy of further promotion. |
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