Totally Laparoscopic Resection for Low Sigmoid and Rectal Cancer Using Natural Orifice Specimen Extraction Techniques

Area of Science:

• Colorectal Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Minilaparotomy for specimen extraction in laparoscopic surgery can lead to wound complications.
• Totally laparoscopic resection with natural orifice specimen extraction (NOSE) is an alternative approach.
• This study investigates NOSE for early-stage colorectal cancer.

Purpose of the Study:

• To evaluate the outcomes of totally laparoscopic colorectal cancer resection using transanal specimen extraction.
• To assess the safety and efficacy of this technique for early-stage sigmoid and rectal cancers.

Main Methods:

• A review of a prospectively maintained database from 2008 to 2013.
• Analysis of patients undergoing totally laparoscopic resection for clinical stage I and IIA low sigmoid colon and rectal cancers.
• Inclusion of patients who had high anterior resections with transanal specimen extraction and low anterior resections with transanal pull-through.

Main Results:

• A total of 72 patients were analyzed (40 high anterior resections, 32 low anterior resections).
• Conversion to conventional laparoscopy occurred in 8 patients (11%).
• Anastomotic leakage was observed in 4 patients (5.6%), with no mortality or cancer recurrence during follow-up (42.5±16.2 months).

Conclusions:

• Transanal specimen extraction is a viable NOSE technique for totally laparoscopic surgery.
• It shows promise as a surgical intervention for early-stage low sigmoid colon and rectal cancers.
• The technique may help mitigate postoperative wound complications associated with minilaparotomy.