Different Methods of Natural Orifice Specimen Extraction Surgery (NOSES) in Laparoscopic Anterior Resection for...

Conventional laparoscopic anterior resection for rectal and low sigmoid colon cancer usually requires an additional abdominal incision to remove specimen and make anastomosis which possibly lead to postoperative pain, incisional infection, incisional hernia, and scarring.

The aim of this study was to investigate the safety and feasibility of different specimen extraction strategies in laparoscopic anterior resection for rectal and low sigmoid colon cancer.

Two-center study.

Patients with rectum and low sigmoid colon cancer who accepted laparoscopic anterior resection for rectal and low sigmoid colon cancer.

A cohort of 632 patients was enrolled. Propensity score matching (PSM) was applied to balance baseline data among three groups. Each group contains 23 cases. Controlled group: specimens were extracted through abdominal incision. Pull-out-method group: specimens were extracted by transanal pull-through coloanal anastomosis. Turn-out-method group: specimens were extracted by turn-rectum-out method. Clinical effects of the three extraction techniques were compared.

There is no significant difference in surgery time, lymph nodes, blood loss, or incidence of postoperative complications in 1 week, hospital time, and financial cost (p > 0.05, respectively). Tumor diameter and postoperative visual analogue scale (VAS) pain scores of controlled group were significantly higher than those of the pull-out-method group and turn-out-method group (p < 0.05, respectively). Pull-out-method group and turn-out-method group had shorter time to ambulation and first flatus than the control group (p < 0.05, respectively). No difference in prognosis was found among the three groups (p > 0.05).

Small sample size.

Pull-out-method and turn-out-method are safe and available in laparoscopic anterior resection for rectal and low sigmoid colon cancer. Traditional abdominal incision strategy is suitable for larger specimens, whereas the pull-out-method strategy and turn-rectum-out strategy cause less trauma and have quicker recovery.