Natural orifice specimen extraction in laparoscopic colorectal cancer surgery: A case series study

Medium-term oncological outcomes of totally laparoscopic colectomy with intracorporeal anastomosis for right-sided and left-sided colon cancer: propensity score matching analysis

Background

This retrospective study aimed to compare long-term oncological outcomes between laparoscopic-assisted colectomy (LAC) with extracorporeal anastomosis (EA) and totally laparoscopic colectomy (TLC) with intracorporeal anastomosis (IA) for colon cancers, including right- and left-sided colon cancers.

Methods

Patients with stage I–III colon cancers who underwent elective laparoscopic colectomy between January 2013 and December 2017 were analyzed retrospectively. Patients converted from laparoscopic to open surgery and R1/R2 resection were excluded. Propensity score matching (PSM) analysis (1:1) was performed to overcome patient selection bias.

Results

A total of 388 patients were reviewed. After PSM, 83 patients in the EA group and 83 patients in the IA group were compared. Median follow-up was 56.5 months in the EA group and 55.5 months in the IA group. Estimated 3-year overall survival (OS) did not differ significantly between the EA group (86.6%; 95% confidence interval (CI), 77.4–92.4%) and IA group (84.8%; 95%CI, 75.0–91.1%; P = 0.68). Estimated 3-year disease-free survival (DFS) likewise did not differ significantly between the EA group (76.4%; 95%CI, 65.9–84.4%) and IA group (81.0%; 95%CI, 70.1–88.2%; P = 0.12).

Conclusion

TLC with IA was comparable to LAC with EA in terms of 3-year OS and DFS. TLC with IA thus appears to offer an oncologically feasible procedure.

Influence of transvaginal laparoscopic surgery on sexual function, life quality and short-term efficacy of patients diagnosed with colorectal cancer

OBJECTIVE

To analyze the effect of transvaginal specimen removal on sexual function, life quality and short-term efficacy of patients diagnosed with colorectal cancer.

METHOD

We retrospectively analyzed the clinical data of 100 patients with colorectal cancer treated in the Cancer Hospital Chinese Academy of Medical Sciences from September 2017 to December 2019. Among them, 52 patients who underwent transvaginal laparoscopic mid-to-high rectal cancer radical resection without assisted abdominal incision who were chosen as the observation group, and 48 patients with conventional laparoscopic-assisted mid-to-high rectal cancer radical resection were set as the control group. Intraoperative blood loss, number of lymph nodes retrieved, operation time, time of urinary catheter removal, drainage tube removal time and postoperative hospital stay were recorded and compared between the two groups. During the process, the Visual Analogue Scale (VAS) was used to assess the pain status of both groups of patients 24 hours after the operation, and the Female Sexual Function Index was used to evaluate the sexual function quality of patients before and 3 months after surgery. Postoperative complications, 2-year survival rate and 6-month postoperative quality of life of both groups of patients were evaluated and compared.

RESULTS

In comparison with the control group, the amount of intraoperative blood loss, catheter removal time, drainage tube removal time, and length of postoperative hospital stay were significantly reduced in the observation group, while the number of lymph nodes retrieved was significantly greater. The VAS score 24 hours after operation was lower in the observation group compared with the control group, with statistical significance. There was no significant difference in postoperative sexual function and complication rates between the two groups. However, the 2-year survival rate and the quality of life 6 months after surgery were comparatively higher in the observation group.

CONCLUSION

Natural orifice specimen extraction surgery (NOSES) is effective for transvaginal specimen removal of patients with colorectal cancer, and can significantly improve the prognosis and life quality of patients without affecting their sexual function, with a high safety profile, which is worthy of clinical promotion.

Laparoscopic Subtotal Gastrectomy and Sigmoidectomy Combined With Natural Orifice Specimen Extraction Surgery (NOSES) for Synchronous Gastric Cancer and Sigmoid Colon Cancer: A Case Report

Background

Gastric cancer and colon cancer are rarely seen in clinic, but there are still related reports. For gastric cancer and simultaneous colon cancer, surgical resection is the main treatment. Traditional surgery requires an incision from xiphoid process to pubic symphysis. With the progress of minimally invasive technology, laparoscopic surgery is also used in the treatment of gastric cancer, but also in the abdominal incision to remove specimens and in vitro anastomosis of digestive tract. Taking specimens through the natural cavity as a new surgical method can not only reduce the abdominal incision, but also reduce the occurrence of wound-related complications. Here, we report a patient with gastric cancer and colon cancer who was treated in our hospital.

Case Summary

We report a series of patients with gastric cancer and colon cancer. upper abdominal pain was treated in our hospital for 6 months. electronic gastroscopy showed large irregular ulcers on the lesser curvature of the gastric antrum and biopsy showed poorly differentiated adenocarcinoma of the gastric antrum. The enhanced CT of abdomen and pelvis showed irregular thickening of gastric antrum wall, irregular thickening of sigmoid colon wall and no obvious enlarged lymph nodes around. Further electronic enteroscopy showed that the sigmoid colon showed cauliflower protuberance, the intestinal cavity was slightly narrow, the intestinal wall was stiff, and the biopsy pathology showed moderately differentiated adenocarcinoma of the sigmoid colon. No obvious abnormality was found in serological tumor indexes. We diagnosed gastric cancer with sigmoid colon cancer and the patient received Laparoscopic subtotal gastrectomy and sigmoidectomy combined with natural orifice specimen extraction surgery. At present, 12 months after operation, no clear tumor recurrence was found in the metastasis.

Conclusion

We should improve the understanding of gastric cancer and sigmoid cancer and combine examination with pathology to avoid misdiagnosis as metastatic cancer. Laparoscopic subtotal gastrectomy should be performed for tumors with no serosa invasion, body mass index <30 and tumor diameter <6.5 cm. Sigmoidectomy combined with natural nostril sampling is feasible.