Top

International Journal of Colorectal Disease

Published in:

01-09-2014 | Original Article

Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer

Authors: Zhang Xingmao, Zhou Haitao, Liang Jianwei, Hou Huirong, HU Junjie, Zhou Zhixiang

Published in: International Journal of Colorectal Disease | Issue 9/2014

Abstract

Purpose

The purposes of this study were to compare the short-term outcomes of natural orifice specimen extraction (NOSE) and laparoscopic-assisted resection for sigmoid colon cancer or rectal cancer and to appraise whether totally laparoscopic resection with NOSE had more advantages compared with conventional laparoscopic-assisted resection.

Methods

Sixty-five patients who underwent totally laparoscopic resection with NOSE were assigned to NOSE group, and 132 patients who underwent laparoscopic-assisted resection were assigned to laparoscopic-assisted (LA) group. Data of all 197 cases were reviewed. Short-term outcomes (including operative outcomes, gastrointestinal recovery, hospital stay, and complication) of the two groups were compared.

Results

Mean numbers of lymph nodes harvested were 17.0 ± 8.3 and 18.9 ± 11.6 in NOSE group and LA group, respectively, (P = 0.248); mean operative times were 111.6 ± 25.4 min and 115.3 ± 23.0 min in the two groups (P = 0.384); and the mean blood losses in these two groups were 70.2 ± 66.1 ml and 126.3 ± 58.6 ml, respectively, (P < 0.001). Times to first flatus were 2.7 ± 0.8 and 3.4 ± 0.9 days (P < 0.001), and times to first defecation were 3.3 ± 0.6 and 3.9 ± 1.1 days (P = 0.002) in NOSE group and LA group, respectively. Hospital stay in NOSE group were 9.0 ± 1.9 and 9.9 ± 2.0 days in LA group. Incidences of peri-operative complications were 6.2 and 17.2 % in the two groups, respectively (P = 0.031).

Conclusions

Without compromising oncologic outcome, totally laparoscopic resection with NOSE had more advantages including less blood loss, less pain, faster recovery of intestinal function and shorter hospital stay compared with laparoscopic-assisted resection for selected patients with sigmoid colon cancer or rectal cancer.

McKenzie S, Baek JH, Wakabayashi M, Garcia-Aguilar J, Pigazzi A (2010) Totally laparoscopic right colectomy with trans-vaginal specimen extraction: the author’s initial institutional experience. Surg Endosc 24:2048–2052PubMedCrossRef

Choi GS, Park IJ, Kang BM, Lim KH, Jun SH (2009) A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer. Surg Endosc 23:2831–2835PubMedCrossRef

Ooi BS, Quah HM, Fu CW, Eu KW (2009) Laparoscopic high anterior resection with natural orifice specimen extraction (NOSE) for early rectal cancer. Tech Coloproctol 13:61–64PubMedCrossRef

Nishimura A, Kawahara M, Suda K, Makino S, Kawachi Y, Nikkuni K (2011) Totally laparoscopic sigmoid colectomy with transanal specimen extraction. Surg Endosc 25:3459–3463PubMedCrossRef

Wolthuis AM, Van Geluwe B, Fieuws S, Penninckx F, D'Hoore A (2012) Laparoscopic sigmoid resection with transrectal specimen extraction: a systematic review. Colorectal Dis 14:1183–1188PubMedCrossRef

Franklin ME Jr, Liang S, Russek K (2013) Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol 17:63–67CrossRef

Jorge JM, Wexner SD (1993) Etiology and management of fecal incontinence. Dis Colon Rectum 36:77–97PubMedCrossRef

D'Hoore A, Wolthuis AM (2011) Laparoscopic low anterior resection and transanal pull-through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique. Colorectal Dis 13:28–31PubMedCrossRef

Roscio F, Bertoglio C, De Luca A, Frattini P, Scandroglio I (2012) Totally laparoscopic versus laparoscopic assisted right colectomy for cancer. Int J Surg 10:290–295PubMedCrossRef

10.

Polignano FM, Quyn AJ, Sanjay P, Henderson NA, Tait IS (2012) Totally laparoscopic strategies for the management of colorectal cancer with synchronous liver metastasis. Surg Endosc 26:2571–2578PubMedCrossRef

11.

Akamatsu H, Omori T, Oyama T, Tori M, Ueshima S, Nakahara M, Abe T, Nishida T (2009) Totally laparoscopic sigmoid colectomy: a simple and safe technique for intracorporeal anastomosis. Surg Endosc 23:2605–2609PubMedCrossRef

12.

Park JS, Choi GS, Kim HJ, Park SY, Jun SH (2011) Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. Br J Surg 98:710–715PubMedCrossRef

13.

Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Yamaguchi T (2009) Short-term outcomes of laparoscopic rectal surgery for primary rectal cancer in elderly patients: is it safe and beneficial? J Gastrointest Surg 13:1614–1618PubMedCrossRef

14.

Bucher P, Wutrich P, Pugin F, Gonzales M, Gervaz P, Morel P (2008) Totally intracorporeal laparoscopic colorectal anastomosis using circular stapler. Surg Endosc 22:1278–1282PubMedCrossRef

Title: Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer
Authors: Zhang Xingmao
Zhou Haitao
Liang Jianwei
Hou Huirong
HU Junjie
Zhou Zhixiang
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 9/2014
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-014-1950-7

At a glance: The STEP trials

Springer Medicine

Totally laparoscopic resection with natural orifice specimen extraction (NOSE) has more advantages comparing with laparoscopic-assisted resection for selected patients with sigmoid colon or rectal cancer

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2014

Incidence and prognosis of lower rectal cancer with limited extramesorectal lymph node metastasis

Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment

The impact of surgical specialisation on survival following elective colon cancer surgery

Advances in the management of colorectal cancer: from biology to treatment

Evaluation of four comorbidity indices and Charlson comorbidity index adjustment for colorectal cancer patients

Colon diversion versus primary colonic repair in gunshot abdomen with penetrating colon injury in Libyan revolution conflict 2011 (a single center experience)