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Huang B, Liu MC, Gao W, Tang J, Zhu Z, Chen L, Han JY, Zhou ZQ, Fu CG. Nomogram for predicting the feasibility of natural orifice specimen extraction after laparoscopic rectal resection. J Gastroenterol Hepatol 2021; 36:1803-1811. [PMID: 33150976 DOI: 10.1111/jgh.15333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM The goal of this study was to develop a preoperative nomogram for predicting the feasibility of trans-anal natural orifice specimen extraction (NOSE) for rectal cancer. METHODS The analysis included 201 patients who underwent trans-anal NOSE and 457 patients who failed to undergo trans-anal NOSE in Shanghai East Hospital. The data collected included age, gender, body mass index, presence of tumor obstruction, distance from anal verge; maximum tumor diameter and anteroposterior thickness of mesorectum (AP) measured by magnetic resonance imaging; interspinous diameter, intertuberous diameter (IT), anteroposterior diameter of the inlet (API), anteroposterior diameter of the midplane, anteroposterior diameter of the outlet (APO), sacral length and pelvic depth (PD) measured by computed tomography. RESULTS The multivariate analysis suggested that a lower body mass index (P < 0.001), no tumor obstruction (P = 0.005), a shorter distance from anal verge (P < 0.001), a smaller tumor size (P < 0.001), a thinner AP (P < 0.001), a wider and shallower bony pelvis (API/PD, P < 0.001), and a wider and shorter pelvic outlet (IT/APO, P < 0.001) were significantly associated with an increased probability of trans-anal NOSE. Successful NOSE patients had a decreased time to liquid intake (P < 0.001), a shorter postoperative hospital stay (P < 0.001), and fewer wound infections (P = 0.045). No significant difference in the rate of mortality or recurrence was observed. The nomogram model presented an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.78 to 0.85) and good calibration. CONCLUSION We developed a nomogram model that has some predicative value for the feasibility of laparoscopic rectal resection with trans-anal NOSE, utilizing clinical and radiologic parameters, available in most institutions.
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Affiliation(s)
- Ben Huang
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Meng-Cheng Liu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Wei Gao
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Jie Tang
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhe Zhu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Lin Chen
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Jun-Yi Han
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhu-Qing Zhou
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Chuan-Gang Fu
- Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, Shanghai, China.,Department of General Surgery, Shanghai East Hospital, Tongji University, Shanghai, China
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Standard versus eversion-modified double-staple technique for low colorectal anastomoses after resection of rectal cancer. Surg Today 2020; 51:785-791. [PMID: 33128593 PMCID: PMC8055572 DOI: 10.1007/s00595-020-02174-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/06/2020] [Indexed: 12/25/2022]
Abstract
Purpose The double-staple technique, performed as either the standard procedure or after eversion of the rectal stump, is a well-established method of performing low colorectal anastomoses following the resection of rectal cancer. Eversion of the tumor-bearing ano-rectal stump was proposed to allow the linear stapler to be fired at a safe distance of clearance from the tumor. We conducted this study to compare the results of the standard versus the eversion-modified double-staple technique. Methods The subjects of this retrospective study were 753 consecutive patients who underwent low stapled colorectal anastomosis after resection of rectal cancer. The patients were divided into two groups according to the method of anastomosis used: Group A comprised 165 patients (22%) treated with the modified eversion technique and group B comprised 588 patients (78%) treated with the standard technique. The primary endpoints of the study were postoperative mortality, surgery-related morbidity, the number of sampled lymph nodes in the mesorectum, and late disease-related survival. Results Postoperative mortality was 1.2% in group A and 1.7% in group B (p = 0.66). Postoperative morbidity was 12% in group A and 11% in group B (p = 0.75). The mean number of sampled lymph nodes in the mesorectum was 23 (range 17–27) in group A and 24 (range 19–29) in group B (p = 0.06). The 5-year disease-related survival was 73% in group A and 74% in group B (p = 0.75). Conclusion The standard and eversion-modified double-staple techniques yield comparable results.
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Hu JH, Li XW, Wang CY, Zhang JJ, Ge Z, Li BH, Lin XH. Short-term efficacy of natural orifice specimen extraction surgery for low rectal cancer. World J Clin Cases 2019; 7:122-129. [PMID: 30705889 PMCID: PMC6354094 DOI: 10.12998/wjcc.v7.i2.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/25/2018] [Accepted: 01/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This case-control study compared the short-term clinical efficacy of natural orifice specimen extraction surgery (NOSES) using a prolapsing technique and the conventional laparoscopic-assisted approach for low rectal cancer.
AIM To further explore the application value of the transanal placement of the anvil and to evaluate the short-term efficacy of NOSES for resecting specimens of low rectal cancer, as well as to provide a theoretical basis for its extensive clinical application.
METHODS From June 2015 to June 2018, 108 consecutive laparoscopic-assisted low rectal cancer resections were performed at our center. Among them, 26 specimens were resected transanally using a prolapsing technique (NOSES), and 82 specimens were resected through a conventional abdominal wall small incision (LAP). A propensity score matching method was used to select 26 pairs of matched patients, and their perioperative data were analyzed.
RESULTS The baseline data were comparable between the two matched groups. All 52 patients underwent the surgery successfully. The operative time, blood loss, number of harvested lymph nodes, postoperative complication rate, circumferential margin involvement, postoperative follow-up data, and postoperative anal function were not statistically significant. The NOSES group had shorter time to gastrointestinal function recovery (2.6 ± 1.0 d vs 3.4 ± 0.9 d, P = 0.006), shorter postoperative hospital stay (7.1 ± 1.7 d vs 8.3 ± 1.1 d, P = 0.003), lower pain score (day 1: 2.7 ± 1.8 vs 4.6 ± 1.9, day 3: 2.0 ± 1.1 vs 4.1 ± 1.2, day 5: 1.7 ± 0.9 vs 3.3 ± 1.0, P < 0.001), a lower rate of additional analgesic use (11.5% vs 61.5%, P = 0.001), and a higher satisfaction rate in terms of the aesthetic appearance of the abdominal wall after surgery (100% vs 23.1%, P < 0.001).
CONCLUSION NOSES for low rectal cancer can achieve satisfactory short-term efficacy and has advantages in reducing postoperative pain, shortening the length of postoperative hospital stay, and improving patients’ satisfaction in terms of a more aesthetic appearance of the abdominal wall.
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Affiliation(s)
- Jun-Hong Hu
- Department of Anorectal Surgery, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
| | - Xing-Wang Li
- Department of Anorectal Surgery, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
| | - Chen-Yu Wang
- Department of Anorectal Surgery, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
| | - Jun-Jie Zhang
- Department of Anorectal Surgery, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
| | - Zheng Ge
- Department of Anorectal Surgery, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
| | - Bing-Hui Li
- Department of Anorectal Surgery, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
- Evidence-Based Medicine Center, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
| | - Xu-Hong Lin
- Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
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Izquierdo KM, Unal E, Marks JH. Natural orifice specimen extraction in colorectal surgery: patient selection and perspectives. Clin Exp Gastroenterol 2018; 11:265-279. [PMID: 30087574 PMCID: PMC6063249 DOI: 10.2147/ceg.s135331] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Over the past 30 years, colorectal surgery has evolved to include minimally invasive surgical techniques. Minimally invasive surgery is associated with reduced postoperative pain, reduced wound complications, earlier return of bowel function, and possibly shorter length of hospital stay. These benefits have been attributed to a reduction in operative trauma compared to open surgery. The need to extract the specimen in colorectal operations through a “mini-laparotomy” can negate many of the advantages of minimally invasive surgery. Natural orifice specimen extraction (NOSE) is the opening of a hollow viscus that already communicates with the outside world, such as the vagina or distal gastrointestinal tract, in order to remove a specimen. The premise of this technique is to reduce the trauma required to remove the specimen with the expectation that this may improve outcomes. Reduction in postoperative analgesic use, quicker return of bowel function, and shorter length of hospital stay have been observed in colorectal operations with NOSE compared to conventional specimen extraction. While the feasibility of NOSE has been demonstrated in colorectal surgery, failures of this technique have also been described. Selection of patients who can successfully undergo NOSE needs further investigation. This review aims to guide surgeons in appropriately selecting patients for NOSE in colorectal surgery. Patient and specimen characteristics are reviewed in order to define patient populations in which NOSE is likely to be successful. Randomized trials comparing NOSE to conventional specimen extraction in colorectal surgery tend to enroll patients with favorable characteristics (body mass index <30, American Society of Anesthesiologists class ≤3, specimen diameter <6.5 cm) and demonstrate improved outcomes. Adopters of NOSE should restrict using this technique to the populations in which feasibility has been defined in the literature. Wider application to other populations, particularly patients with body mass index >30 and those with significant comorbidities, requires further study.
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Affiliation(s)
- Kevin M Izquierdo
- Division of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA,
| | - Ece Unal
- Division of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA,
| | - John H Marks
- Division of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA,
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Zattoni D, Popeskou GS, Christoforidis D. Left colon resection with transrectal specimen extraction: current status. Tech Coloproctol 2018; 22:411-423. [PMID: 29948523 DOI: 10.1007/s10151-018-1806-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Full laparoscopic left colectomy with transrectal specimen extraction is proposed as an improvement of the minimally invasive surgical technique. This paper reviews in detail the current status of left-sided colectomy and upper rectum resection with transrectal specimen extraction. METHODS A systematic review was performed of all types of publications on colorectal resection with natural orifice specimen extraction (NOSE). We only included studies reporting on left colectomy, sigmoidectomy, and high anterior resection with transrectal specimen extraction (TRSE), excluding transanal (TASE), transvaginal, or transcolonic specimen extraction. Surgical techniques, patient characteristics, and outcomes were reviewed in detail. RESULTS Thirty-five papers reported on TRSE (2 randomized clinical trials, 7 case-matched series, 19 case series, 5 case reports, and 2 articles on surgical technique). We found a wide variety of innovative anastomotic and specimen extraction techniques. After excluding duplicates and papers reporting mixed TRSE and TASE results, outcomes in patients undergoing TRSE from 23 publications showed a conversion rate to conventional laparoscopy of 3.7% (21/559), overall morbidity 9.5% (53/559) [major in 2.9% (16/559), intra-abdominal infection in 2.1% (12/559)]. No mortality was reported. Postoperative anal incontinence was rarely reported. Several studies showed a decrease in postoperative pain and some in length of hospital stay. CONCLUSIONS Colectomy with TRSE is feasible and seems safe in selected patients. Reported outcomes seem in general similar to conventional laparoscopic colectomy with a possible benefit in postoperative pain and length of hospital stay. Obvious selection bias and lack of high quality trials do not allow firm conclusions to be drawn.
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Affiliation(s)
- D Zattoni
- Department of General Surgery, Ospedale per gli Infermi di Faenza, 48018, Faenza, Italy.
| | - G S Popeskou
- Department of General Surgery, Queen Elisabeth University Hospital, Birmingham, UK
| | - D Christoforidis
- Department of General Surgery, Ospedale Civico di Lugano, 6900, Lugano, Switzerland
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Chen J, Li Y, Xi X, Qiao L, Yang M, Xia L, Zhou Y. Clinical Values of Preoperative Use of Antibiotics in Transanal Endoscopic Microsurgery. J INVEST SURG 2017; 31:548-554. [PMID: 28829669 DOI: 10.1080/08941939.2017.1356402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To investigate the clinical values of preoperative use of antibiotics in transanal endoscopic microsurgery (TEM). METHODS Thirty patients undergoing TEM surgery to treat rectal neoplasms in our hospital were selected in this study. All patients were randomly divided into two groups: antibiotic group that antibiotics were used before and after surgery, and control group that antibiotics were only used after surgery. Several markers were evaluated before and after surgery in all patients, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), changes procalcitonin (PCT), white blood cell count (WBC), neutrophils (NE%) and temperature (T). RESULTS The patients in the antibiotic group at the first and third days after surgery showed lower values of ESR, CRP, WBC, NE% and T than the control group (p < 0.05), furthermore, the WBC and NE% were significantly decreased at the third day after surgery compared with the first day after surgery. For the PCT, there was a significant difference in the first day after surgery between the two groups (p < 0.05), but no significant difference was observed between them at the third day after surgery (p > 0.05). CONCLUSION The preoperative use of antibiotics in TEM surgery to treat rectal neoplasms may become an effective method to reduce inflammation and prevent infecting after surgery, which will be verified by an amount of studies on large sample.
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Affiliation(s)
- Jingbo Chen
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China.,b Department of General Surgery , The Affiliated Hospital of Qingdao University , No. 16 Jiangsu Road, Qingdao 266071 , Shandong , China
| | - Yupeng Li
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Xiangpeng Xi
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Lili Qiao
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Mingyu Yang
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Lijian Xia
- a Department of General Surgery, Shandong Provincial Qianfoshan Hospital , Shandong University , Jinan 250014 , Shandong , China
| | - Yanbing Zhou
- b Department of General Surgery , The Affiliated Hospital of Qingdao University , No. 16 Jiangsu Road, Qingdao 266071 , Shandong , China
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