Perioperative Efficacy Of Natural Orifice Specimen Extraction Surgery (NOSES) And Conventional Laparoscopic Surgery (CL) In The Treatment Of Colorectal Neoplasms:A Meta-analysis

Objective: To compare the perioperative effects of the treatment of colorectal neoplasms through natural orifice specimen extraction surgery(NOSES)and conventional laparoscopic surgery(CL)through a Meta-analysisMethods: Mainly search Chinese and English databases such as PubMed,EMBASE,Cochrane Library,Sciencedirect,China National Knowledge Infrastructure(CNKI),Wanfang Data Knowledge Service Platform,China Science and Technology Journal Database(CQ-VIP),China Biology Medicine disc(CBMdisc),etc.The related clinical research on the comparison of the efficacy of NOSES and CL for colorectal neoplasms(as of December 2019),two independent researchers screened the literature,evaluated the quality of the literature and extracted relevant index data,and finally used Rev Man 5.3software for statistical analysis.Results: A total of 13 clinical studies(4 RCTs and 9 NRCTs)were included,and a total of 1732 patients were finally included.The results are as follows: in terms of intraoperative effects,There was no significant difference in the length of the two surgical procedures(P=0.12)and the number of lymph node dissections(P=0.37),While the intraoperative blood loss of NOSES was less(P<0.00001).In terms of postoperative effect,the time to first flatus of NOSES was shorter(P = 0.003),postoperative pain relief(P<0.00001),postoperative appearance satisfaction was higher(P<0.00001),and postoperative hospital stay was shorter(P<0.0001),and the overall postoperative complication rate is lower(P = 0.0009),in which intestinal obstruction and incision infection are reduced(P = 0.02;P<0.0001),there is no significant difference in anastomotic leakage and intra-abdominal infection(P=0.84;P=0.49).There was no statistically significant difference in the 3-year and 5-year disease-free survival rates between the two surgical methods in terms of long-term oncology outcomes(P=0.56;P=0.74).Conclusion: Compared with CL surgery,there is no significant difference in the operation time of NOSES treatment and the number of intraoperative lymph node dissection for colorectal neoplasms,but the treatment of colorectal neoplasms with NOSES has less intraoperative blood loss,faster recovery of gastrointestinal function,less postoperative pain,and fewer overall complications.It can shorten the length of hospital stay and accelerate postoperative rehabilitation,and has certain application value and prospects,but long-term oncology efficacy still needs more and higher levels of evidence-based results for further evaluation.