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Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer: mid-term results of a case-matched study

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Abstract

Background

Although the vagina is considered a viable route during laparoscopic surgery, a number of concerns have led to a need to demonstrate the safety of a transvaginal approach in colorectal surgery. However, the data for transvaginal access in left-sided colorectal cancer are extremely limited, and no study has compared the clinical outcomes with a conventional laparoscopic procedure.

Objective

We compared the clinical outcomes of totally laparoscopic anterior resection with transvaginal specimen extraction (TVSE) with those of the conventional laparoscopic approach with minilaparotomy (LAP) for anastomosis construction and specimen retrieval in left-sided colorectal cancer.

Methods

Fifty-eight patients underwent TVSE between October 2006 and July 2011 and were matched by age, surgery date, tumor location, and tumor stage with patients who underwent conventional LAP for left-sided colorectal cancer.

Results

Operative time was significantly longer in the TVSE group (149.3 ± 39.8 vs. 131.9 ± 41.4 min; p = 0.023). Patients in the TVSE group experienced less pain (pain score 4.9 ± 1.6 vs. 5.8 ± 1.9; p = 0.008), shorter time to passage of flatus (2.2 ± 1.1 vs. 2.7 ± 1.2 days; p = 0.026), and higher satisfaction with the cosmetic results (cosmetic score 8.0 ± 1.4 vs. 6.3 ± 1.5; p = 0.001). More endolinear staplers for rectal transection were used in the LAP group (1.2 ± 0.5 vs. 1.1 ± 0.2; p = 0.021). Overall morbidities were similar in both groups; however, three wound infections only occurred in the LAP group. After a median follow-up of 34.4 (range 11–60) months, no transvaginal access-site recurrence occurred. The 3-year disease-free survival was similar between groups (91.5 vs. 90.8 %; p = 0.746).

Conclusions

Transvaginal access after totally laparoscopic anterior resection is safe and feasible for left-sided colorectal cancer in selected patients with better short-term outcomes.

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Acknowledgments

This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MEST) 2011 (NO.2011-0011004).

Disclosure

Hye Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park, Jong Pil Ryuk, and Sung Hwan Yoon have no conflicts of interest or financial relationships to disclose.

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Authors and Affiliations

  1. Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, 807 Hogukno, Buk-gu, Daegu, 702-210, Korea

    Hye Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park, Jong Pil Ryuk & Sung Hwan Yoon

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  1. Hye Jin Kim
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  2. Gyu-Seog Choi
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Correspondence to Gyu-Seog Choi.

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Kim, H.J., Choi, GS., Park, J.S. et al. Transvaginal specimen extraction versus conventional minilaparotomy after laparoscopic anterior resection for colorectal cancer: mid-term results of a case-matched study. Surg Endosc 28, 2342–2348 (2014). https://doi.org/10.1007/s00464-014-3466-1

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  • DOI: https://doi.org/10.1007/s00464-014-3466-1

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