Comparison Of The Safety Between Natural Orifice Specimen Extraction (NOSE) And Conventional Laparoscopic Surgery In The Treatment Of Rectal Cancer

Objective: To evaluate the short-term safety and feasibility of specimens taken through natural orifice and abdominal wall in laparoscopic radical resection of rectal cancer.Methods: 129 patients with rectal cancer who underwent radical resection of rectal carcinoma from January 2019 to January 2020 were prospectively observed.All patients were randomly enrolled according to the random number table and divided into the laparoscopic radical rectal cancer specimen collection by natural orifice(N =60)and by abdominal wall(LAP group n=60,failed to complete surgery n=9).NOSES group(37 males,23 females);Age:(57.5±13.7)years old,LAP group(35 males,25 females);The age was(59.7±11.4)years old,and the results were as follows :(1)preoperative general data.(2)Intraoperative and postoperative situation,postoperative anal function and postoperative quality of life were followed up in outpatient department and by telephone until January 2021.(3)Postoperative inflammatory factors and complications.The measurement data of the normal distribution were expressed as Mean±SD,the continuous data of the normal distribution were tested by T test,the graded data were tested by Chi-square test or Fisher’s exact probability method,and the rank sum test was used for non-normal distribution.P<0.05 was considered statistically significant.Results:(1)Preoperative general information: Patients in both groups successfully completed laparoscopic radical resection of rectal cancer without switching to laparotomy.The values of age(NOSES group 57.5±13.7 years old,LAP group 59.7±11.4 years old,P=0.340),gender(P=0.700),body mass index(P=0.715),ASA score(P=0.304),There were no significant differences in preoperative CEA(P=0.426),distance between the tumor and the anal margin(NOSES group4.7±1.6cm,LAP group 5.1±1.4cm,P=0.126),and preoperative depth of tumor invasion(P=0.250).(2)Intraoperative and postoperative conditions: The operative time(NOSES group175.14±33.4min,LAP group 163.8±42.4min,P=0.128)and the postoperative first time of passage gas anus(NOSES group 2.7±1.1d,LAP group 3.5±0.8d,P<0.001),first post-operative movement time(NOSES group 3.6±1.7d,LAP group 5.1±1.7d,P< 0.001),post-operative hospital stay(NOSES group 8.8±2.4d,LAP group 10±3.6d,P=0.037),Vas score(NOSES group 4.6±0.7,2.7±0.6,LAP group 5.5±0.8,3.5±0.7)at the 1st and 3rd postoperative days(P<0.05).The pain score(Vas score)on the 5th postoperative day(NOSES group 1.4±0.6,LAP group 1.5±0.7)was not significantly different between the two groups(P=0.725).The amount of intraoperative blood loss(NOSES group 27.8±27.7ml,LAP group 24.8±31.6ml,P=0.583),the prevention of flow diversion(NOSES group 11,LAP group 9,P=0.568),and the specimen length(NOSES group13.0±4.3cm,LAP group 12.7±3.0cm,P=0.669),the distance between the proximal edge(NOSES8.5±3.3cm LAP 7.8±3.2cm,P=0.253),the distance between the distal edge(NOSES 2.4±0.9cm LAP 2.5±0.7cm)P=0.566),circumferential cutting edge,number of lymphocytes obtained(diluted14.4±3.1 in the LAP group 15.2±3.6 in the LAP group,P=0.161),nerve infringement(NOSES 10,LAP 7,P=0.566),vascular infringement(NOSES 14,LAP 20,P=0.224)and postoperative TNM stage(NOSES 19 cases of Stage Ⅰ,30 cases of stage Ⅱ,11 cases of stage Ⅲ,LAP,25 cases of stage Ⅰ,32 cases of stage Ⅱ,3 cases of stage Ⅲ,P=0.065).(3)Postoperative inflammatory factor levels and complications: There were no statistically significant differences in the absolute values of white blood cells and neutrophils and calcitonin between the two groups on the 1st,3rd and 7th day after surgery,and no bacterial growth was observed in the bacterial culture of the intraoperative rinse solution.Postoperative anastomotic leakage(NOSES 3,LAP group 1),anastomotic bleeding(NOSES 1,LAP 0),There were no significant differences in postoperative intestinal obstruction(NOSES 0,LAP 2),respiratory tract infection(NOSES 2,LAP 4),and incisions infection(NOSES 0,LAP 3)(P>0.05).All 120 patients were followed up until 1 year after surgery.During the follow-up period,there were no statistically significant differences in anal function(Wexner score,P>0.05)and quality of life(QOL score,P> 0.05)between the two groups at 1,6 and 12 months after surgery,and no local recurrence or distant metastasis was found in all cases.Conclusion: Compared with transabdominal wall specimen collection,natural orififice specimen extraction surgery has the advantages of lighter postoperative pain,early postoperative ambulation time and shorter postoperative hospital stay.Taking specimens through the natural orififice will not increase abdominal infection,will not lead to anal function damage and quality of life decline,and will not increase the incidence of postoperative complications.It is a minimally invasive,safe and feasible method of laparoscopic rectal cancer surgical specimen collection.