A Prospective Randomized Controlled Study Of The Effect Of Natural Orifice Specimen Extraction During Robotic Rectal Radical Resection On Stress Response And Cellular Immune Function

Objective:To compare the changes of stress response and immune function between natural orifice specimen extraction during robotic rectal radical resection and conventional robot-assisted radical resectionMethods:This study prospectively included 66 patients with rectal adenocarcinoma who were to undergo robotic radical resection of rectal cancer in the Department of Gastrointestinal Surgery,The First Affiliated Hospital of Nanchang University from May 2020 to March 2021.Inclusion criteria:(1)Age 18-80 years old;(2)ECOG score≤2;(3)Histologically or cytologically confirmed colorectal adenocarcinoma;(4)The tumor was located at the rectum or rectoethyl-junction and the lower margin was more than 5cm from the dentate line;(5)Preoperative staging:T1-3NXM0;(6)Periferal diameter of transrectal Noses≤3 cm,transvaginal Noses≤5 cm;(7)Preoperative examination did not indicate metastasis,implantation or invasion of adjacent organs;(8)Heart,lung,liver and kidney function can tolerate surgery;(9)Signed the informed consent.According to the random number method,all patients were randomly divided into the robotic NOSES group(33 cases)and the routine robotic surgery group(33 cases),respectively,to receive robotic specimen removal through the natural cavity and routine robotic surgery.Clinical and auxiliary examination data of all patients were collected to compare the changes of stress response and immune function of patients in the two groups.Results:2 cases of patients in the robot NOSES group who were found to be unsuitable for NOSE surgery during the operation were excluded,and 1 case in the conventional robot surgery group was found to be a rectal adenoma after postoperative pathology,and was excluded according to the case withdrawal criteria.There was no significant difference in baseline data between the two groups(all P>0.05).There were no significant differences in the levels of white blood cells,neutrophils,CRP,IL-6 and IL-8 in 2 groups on the day before surgery(P>0.05),but the levels of white blood cells,neutrophils,CRP,IL-6 and IL-8 on the first and third day after surgery were all higher than those on the day before surgery,with statistical significance(P<0.05).The white blood cells,neutrophils,CRP,IL-6 and IL-8 in the N1 group were lower than those in the conventional robotic surgery group on the first day after the operation,and the difference was statistically significant(P<0.05).The levels of white blood cells,CRP,IL-6 and IL-8 in the Nose group on the third day after the operation were lower than those in the conventional robot group,the difference was statistically significant(P<0.05).On the seventh day after the operation,there were no statistically significant differences in the levels of white blood cells,neutrophils,IL-6 and IL-8 between the two groups(P>0.05),and the CRP level in the Nose group was lower than that in the conventional robot group(P<0.05).The percentage of CD3~+T cells and CD4/CD8 in the Noses group one day before surgery were not significantly different from those in the conventional robot group(P>0.05).The percentages of CD3~+T cells and CD4/CD8 in the two groups on the first,third and seventh days after the operation were lower than those in the one day before the operation,and the differences were statistically significant(P<0.05).The percentages of CD3~+T cells and CD4/CD8 in the Nosing group were higher than those in the conventional robotic surgery group on the first,third and seventh days after the operation.The difference was statistically significant(P<0.05).Serum albumin and hemoglobin on the first and third day after surgery in 2 groups were lower than the day before surgery,with statistical significance(P<0.05).The albumin and hemoglobin levels in the 1 day before and 1 day after Nosing group were not significantly different from those in the conventional robot group(P>0.05).The albumin and hemoglobin in the 3 rd and 7 th postoperative NOSES were higher than those in the conventional robot group,and the difference was statistically significant(P<0.05).Conclusion:The natural orifice specimen extraction during robotic rectal radical resection may cause a higher short-term inflammatory response in patients after surgery,but does not prolong the inflammatory response time,and returns to normal faster than the conventional robot group.Natural orifice specimen extraction during robotic rectal radical resection has little influence on the immune system of patients,and the recovery is faster,which is conducive to reducing the possibility of postoperative infectious complications and promoting the recovery of patients.