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Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study

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Abstract

Background

Although reduced port laparoscopic surgery (RPLS), defined as laparoscopic surgery performed with the minimum possible number of ports and/or small-sized ports, is less invasive than conventional laparoscopic surgery by reducing the number of surgical wounds, an extension of the incision is still needed for specimen extraction, which can undermine the merits of RPLS.

Objective

To determine the impact of natural orifice specimen extraction (NOSE) in patients undergoing RPLS for colorectal cancer. The endpoints were perioperative outcome and oncologic safety at 3 years.

Setting

Single-center experience (2013–2019).

Patients

We retrospectively analyzed our prospectively collected patient records (American Joint Committee on Cancer (AJCC) stage I–III sigmoid or upper rectal cancer (tumor diameter ≤ 5 cm) who underwent curative anterior resection via RPLS. We excluded patients who did not undergo intestinal anastomosis.

Interventions

Perioperative and oncologic outcomes were compared between patients undergoing natural orifice (RPLS-NOSE) or conventional (mini-laparotomy) specimen extraction (RPLS-CSE). Patients were matched by propensity scores 1:1 for tumor diameter, AJCC stage, American Society of Anesthesiologists score and tumor location.

Results

Of 119 eligible patients, 104 were matched (52 RPLS-NOSE; 52 RPLS-CSE) by propensity scores. Compared with RPLS-CSE, RPLS-NOSE was associated with longer operative time (223.9 vs. 188.7 min; p = 0.003), decreased use of analgesics (morphine dose 33.9 vs. 43.4 mg; p = 0.011) and duration of hospital stay (4.2 vs. 5.1 days; p = 0.001). No statistically significant difference was found in morbidity or wound-related complication rates between the two groups. After a median follow-up of 34.3 months, no local recurrence was observed in RPLS-NOSE. The 3-year disease-free survival did not differ statistically significantly between groups (90.9 vs. 90.5%; p = 0.610).

Conclusion

NOSE enhances the advantages of RPLS by avoiding the need for abdominal wall specimen extraction in patients with tumor diameter ≤ 5 cm. Surgical and oncologic safety are comparable to RPLS with CSE.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, China Medical University, No. 2, Yu-Der Rd, Taichung, 404, Taiwan

    Sheng-Chi Chang, Yi-Chang Chen, Hung-Chang Chen, Tao-Wei Ke, Yuan-Yao Tsai & William Tzu-Liang Chen

  2. Department of Life Sciences, National Chung Hsing University, No.145, Rd. Xingda, Taichung, Taiwan

    Sheng-Chi Chang & Tsung-Han Lee

  3. Section of Cancer Registry and Screening, Cancer Center, China Medical University Hospital, Taichung, Taiwan

    Mei-Tsz Chen

  4. Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria

    Abe Fingerhut

  5. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai, 200025, People’s Republic of China

    Abe Fingerhut

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  1. Sheng-Chi Chang
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Correspondence to Tsung-Han Lee or William Tzu-Liang Chen.

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Disclosures

Sheng-Chi Chang, Tsung-Han Lee, Yi-Chang Chen, Mei-Tsz Chen, Hung-Chang Chen, Tao-Wei Ke, Yuan-Yao Tsai, Abe Fingerhut, William Tzu-Liang Chen have no conflicts of interest or financial ties to disclose.

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Podium presentation

Partial results of this study were presented at the SAGES 2018 Annual Meeting and 16th World Congress of Endoscopic Surgery, Seattle 2018 (11–14 April 2018). Partial results of this study were presented at the 26th international Congress of the EAES, London 2018 (30 May–1 June 2018).

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Chang, SC., Lee, TH., Chen, YC. et al. Natural orifice versus conventional mini-laparotomy for specimen extraction after reduced-port laparoscopic surgery for colorectal cancer: propensity score-matched comparative study. Surg Endosc 36, 155–166 (2022). https://doi.org/10.1007/s00464-020-08250-8

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