| Objective:To compare the bacterial culture results,tumor cell detection results,short-term complications and prognosis of patients undergoing radical laparoscopic colorectal cancer treatment with complete laparoscopic radical resection of colorectal cancer via natural orifice specimen extraction surgery(CRC-NOSES)and conventional laparoscopic colorectal cancer treatment,to explore the clinical safety of CRC-NOSES,and to add an objective clinical basis for further safe implementation of CRC-NOSES.Methods:In this study,the data of 518 patients who underwent radical surgery for sigmoid and rectal cancer at the Gastrointestinal Surgery in our hospital from January 2018 to November 2022 were collected,including the basic information,bacteriological and oncological findings of the peritoneal irrigation fluid,postoperative pathology,short-term complications,and follow-up data.They were divided into the natural orifice specimen extraction group(NOSE group)and the non-natural orifice specimen extraction group(N-NOSE group)according to the surgical approach.The propensity score matching(PSM)method was used to match the data of the two groups 1:1 to balance the baseline information of the two groups and control for confounding factors to make them more comparable.Bacteriological and oncological outcomes,short-term complications,and prognosis of the two groups were analyzed and compared using statistical software to investigate the clinical safety of CRC-NOSES.The difference was considered statistically significant at p < 0.05.Results:1.Basic information: A total of 216 patients were successfully matched after PSM in the 518 patients included,including 108 patients each in the NOSE and N-NOSE groups.There were significant differences in gender(p<0.001),T-stage(p=0.002),N-stage(p=0.009),tumour size(p=0.030)and tumour location(p<0.001)between the two groups before matching.There were no statistically significant differences in age,gender,body mass index(BMI),T-stage,N-stage,diabetic condition,tumour size and tumour location between the two groups after matching.2.Bacteriological results: After PSM,the rate of positive bacterial culture of the peritoneal washings was higher in the NOSE group(38.9%)than in the N-NOSE group(23.1%)and the difference was statistically significant(p=0.012).The bacterial species obtained by bacterial culture included Escherichia coli(73.13%),Klebsiella pneumoniae(13.43%),Enterococcus faecalis(2.99%),Enterococcus faecalis(4.48%),Enterobacter aerogenes(2.99%),Proteus vulgaris(1.49%)and Enterobacter cloacae(1.49%).3.Major short-term complications: the differences between the NOSE and N-NOSE groups in terms of incidence of pneumonia(p=0.052),anastomotic bleeding(p=0.500),anastomotic fistula(p=0.775),incisional infection(p=0.245)and intra-abdominal infection(p=0.789)were not statistically significant.No patients with anastomotic bleeding or incisional infection were observed in the NOSE group.As the rate of positive bacterial cultures was significantly higher in the NOSE group than in the N-NOSE group,we performed further correlation analysis between bacterial culture results and abdominal infection and showed that whether in the NOSE group(p=0.503),the N-NOSE(p=0.201)group or all matched patients(p=0.174),positive bacterial culture results and the occurrence of abdominal infection was not significantly correlated.4.Oncological outcome and prognosis: The positive rate of tumour cell detection in the peritoneal washings was 8.3% in the NOSE group and 5.6%in the N-NOSE group,and there was no significant difference in the results of tumour cell detection in the peritoneal washings between the two groups(p=0.442).The differences in overall survival(OS)and disease-free survival(DFS)between the two groups were not significant.Conclusions:Compared to conventional laparoscopic radical colorectal cancer treatment,CRC-NOSES is not inferior in terms of bacteriological and oncological outcomes and prognosis and could be further promoted in the clinic. |
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