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Xu SZ, Wang ZF, Ding ZJ, Zhang SF, Yuan SB, Yan F, Liu GY, Cai JC. Comparative long-term outcomes of natural orifice specimen extraction surgery and conventional laparoscopic colectomy for left-sided colorectal cancer: a propensity score-matched analysis. Int J Surg 2024; 110:1402-1410. [PMID: 38484259 PMCID: PMC10942156 DOI: 10.1097/js9.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/21/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Natural orifice specimen extraction surgery (NOSES) is currently widely used in left-sided colorectal cancer. Some clinical comparative studies have been conducted, providing evidence of its safety and oncological benefits. However, these studies are typically characterized by small sample sizes and short postoperative follow-up periods. Consequently, in this research, the authors adopt the propensity score matching method to undertake a large-scale retrospective comparative study on NOSES colectomy for left-sided colorectal cancer, with the goal of further augmenting the body of evidence-based medical support for NOSES. METHODS This retrospective study involved patients who underwent NOSES colectomy and conventional laparoscopic (CL) colectomy for left-sided colorectal cancer between January 2014 and April 2021. In the NOSES group, specimens were extracted through the anus with the help of a Cai tube (homemade invention: ZL201410168748.2). The patients were matched at a ratio of 1:1 according to age, sex, BMI, tumor diameter, tumor location (descending and splenic flexure colon/ sigmoid colon/ middle and upper rectum), tumor height from anal verge, ASA grade, previous abdominal surgery, clinical pathologic stage, preoperative CEA. After matching, 132 patients in the NOSES group and 132 patients in the CL group were eligible for analysis. RESULTS Compared with CL group, NOSES group was associated with decreased postoperative maximum pain score (2.6±0.7 vs. 4.7±1.7, P=0.000), less additional analgesia required (6.8 vs. 34.8%, P=0.000), faster time to passage of flatus (2.3±0.6 days vs. 3.3±0.7 days, P=0.000), less wound infection (0.0 vs. 6.1%, P=0.007), and longer operative time (212.5±45.8 min vs. 178.0±43.4 min, P=0.000). No significant differences were observed in estimated blood loss, time to resume regular diet, postoperative hospital stay, conversion to open surgery or conventional minilaparotomy, total morbidity, readmission, mortality, pathologic outcomes, and Wexner incontinence score between groups. After a median follow-up of 63.0 months, the 5-year overall survival rates were 88.3 versus 85.0% (P=0.487), disease-free survival rates were 82.9 versus 83.6% (P=0.824), and the local recurrence rates were 4.4 versus 4.0% (P=0.667) in the NOSES and CL groups, respectively. CONCLUSIONS This study suggests that NOSES colectomy using a Cai tube for left-sided colorectal cancer is a safe and feasible option with better cosmetic results, less pain, faster recovery of gastrointestinal function, and comparable long-term clinical and oncologic outcomes to CL colectomy.
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Affiliation(s)
- Shu-Zhen Xu
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Zhen-Fa Wang
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Zhi-Jie Ding
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Shi-Feng Zhang
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Si-Bo Yuan
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Feng Yan
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Guo-Yan Liu
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
| | - Jian-Chun Cai
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, School of Medicine, Xiamen University
- Institute of Gastrointestinal Oncology, School of Medicine, Xiamen University
- Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, Xiamen, Fujian, People’s Republic of China
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Xu SZ, Ding ZJ, Zhang SF, Yuan SB, Yan F, Wang ZF, Liu GY, Cai JC. Clinical outcomes of laparoscopic-assisted natural orifice specimen extraction colectomy using a Cai tube for left-sided colon cancer: a prospective randomized trial. Surg Endosc 2023; 37:749-758. [PMID: 35906459 DOI: 10.1007/s00464-022-09435-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/03/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The role of laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) colectomy in the treatment of left-sided colon cancer has not been well defined, and there remains confusion about how to conveniently exteriorize specimens through natural orifices. Therefore, we introduced a homemade invention, the Cai tube, to facilitate the extraction of specimens and compared the clinical outcomes of LA-NOSE with conventional laparoscopic (CL) colectomy for left-sided colon cancer. METHODS From March 2015 to August 2017, patients with left-sided colon cancer were randomly divided into LA-NOSE and CL groups. Specimens were extracted through the anus with the help of a Cai tube (Patent Number: ZL201410168748.2) in the LA-NOSE group. The primary outcome measure was postoperative pain. Secondary outcomes were the duration of operation, postoperative recovery, surgical morbidity, pathological quality of the specimen, and long-term outcomes, including 3-year overall survival, disease-free survival, local recurrence, and overall recurrence. RESULTS A total of 60 patients (30 per group) were recruited for this study. None of the patients required emergency conversion to conventional laparoscopic or open surgery during the operation. The postoperative maximum pain score was significantly lower in the LA-NOSE group (mean 2.5 vs. 5.1, P = 0.001), as was the additional analgesia requirement (mean 2/30 vs. 10/30, P = 0.021). Patients in the LA-NOSE group experienced a shorter first time to passage of flatus (mean 2.2 vs. 3.1 days, P = 0.026). All patients could control their defecation at 6 months after surgery. The comparison between the two groups showed no significant differences in the operative time, bleeding volume, postoperative hospital stay, surgical morbidity rates, number of lymph nodes harvested, or resection margin status. The mean follow-up was 48 months (range 7-59) and was similar in both groups. The results showed no differences in long-term outcomes between the two groups. CONCLUSION In the treatment of left-sided colon cancer, compared with conventional laparoscopic colectomy, LA-NOSE colectomy using the Cai tube exhibited lower postoperative pain, shorter recovery of gastrointestinal function, and similar long-term outcomes. REGISTRATION NUMBER ChiCTR-OOR-15007060 ( http://www.chictr.org.cn/ ).
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Affiliation(s)
- Shu-Zhen Xu
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
| | - Zhi-Jie Ding
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
| | - Shi-Feng Zhang
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
| | - Si-Bo Yuan
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
| | - Feng Yan
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
| | - Zhen-Fa Wang
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
| | - Guo-Yan Liu
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China
| | - Jian-Chun Cai
- Department of Gastrointestinal Surgery, Zhongshan Hospital Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China. .,Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China. .,Xiamen Municipal Key Laboratory of Gastrointestinal Oncology, No. 201-209, Hubin South Road, Xiamen, 361004, Fujian, China.
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Lin L, Yuan SB, Guo H. Does cranial-medial mixed dominant approach have a unique advantage for laparoscopic right hemicolectomy with complete mesocolic excision? World J Gastrointest Surg 2022; 14:221-235. [PMID: 35432765 PMCID: PMC8984517 DOI: 10.4240/wjgs.v14.i3.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/14/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complete mesocolic excision (CME) with central vascular ligation (CVL) was proposed by Hohenberger in 2009. The CME principle has gradually become the technical standard for colon cancer surgery. How to achieve CME with CVL in laparoscopic right hemicolectomy (LRH) is controversial, and a unified standard approach is not yet available. In recent years, the authors’ team has integrated the theory of membrane anatomy, tried to combine the cephalic approach with the classic medial approach (MA) for technical optimization, and proposed a cranial-medial mixed dominant approach (CMA).
AIM To explore the feasibility of operational approaches for LRH with CME.
METHODS In this retrospective cohort study, the clinical data of 57 patients with right-sided colon cancer (TNM stage I, II, or III) who underwent LRH with CME from January 2016 to June 2020 were collected and summarized. There were 31 patients in the traditional MA group and 26 in the CMA group.
RESULTS There were no significant differences in baseline data between the two groups. The operation was shorter and the number of lymph nodes dissected was higher in the CMA group than in the MA group, but there was no significant difference in the number of positive lymph nodes, intraoperative blood loss, postoperative exhaust time, feeding time, postoperative hospital stay or postoperative complication incidence.
CONCLUSION Our study shows that the CMA is a safe and feasible procedure for LRH with CME and has a unique advantage.
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Affiliation(s)
- Li Lin
- Department of Gastrointestinal Surgery and Xiamen City Key Laboratory of Gastrointestinal Cancer, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Si-Bo Yuan
- Department of Gastrointestinal Surgery and Xiamen City Key Laboratory of Gastrointestinal Cancer, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Huan Guo
- Department of Gastrointestinal Surgery and Xiamen City Key Laboratory of Gastrointestinal Cancer, Zhongshan Hospital, Xiamen University, Xiamen 361000, Fujian Province, China
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