Dataset Information

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer.

ABSTRACT: In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.

SUBMITTER: Guan X

PROVIDER: S-EPMC6375350 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer.

Guan Xu X Liu Zheng Z Longo Antonio A Cai Jian-Chun JC Tzu-Liang Chen William W Chen Lu-Chuan LC Chun Ho-Kyung HK Manuel da Costa Pereira Joaquim J Efetov Sergey S Escalante Ricardo R He Qing-Si QS Hu Jun-Hong JH Kayaalp Cuneyt C Kim Seon-Hahn SH Khan Jim S JS Kuo Li-Jen LJ Nishimura Atsushi A Nogueira Fernanda F Okuda Junji J Saklani Avanish A Shafik Ali A AA Shen Ming-Yin MY Son Jung-Tack JT Song Jun-Min JM Sun Dong-Hui DH Uehara Keisuke K Wang Gui-Yu GY Wei Ye Y Xiong Zhi-Guo ZG Yao Hong-Liang HL Yu Gang G Yu Shao-Jun SJ Zhou Hai-Tao HT Lee Suk-Hwan SH Tsarkov Petr V PV Fu Chuan-Gang CG Wang Xi-Shan XS

Gastroenterology report 20190123 1

In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been ob ...[more]

PMID: 30792863

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Project description:BackgroundNatural orifice specimen extraction (NOSE) is a technique that involves collecting a specimen for extraction through a natural opening avoiding a mini-laparotomy incision. The aim of this study was to compare NOSE and transabdominal specimen extraction in laparoscopic (LAP) colorectal cancer surgery for postoperative outcomes and oncological safety.MethodA systematic search was conducted in five electronic databases from inception till October 2020. Articles were selected based on the inclusion criteria (studies comparing LAP and NOSE colorectal surgeries reporting at least one of the outcomes) and analysed. Primary outcomes included postoperative complications, pathological results (resection margins and lymph node collection), and oncological outcomes. Secondary outcomes included operating time, blood losses, use of analgesics, functional recovery, duration of hospital stay, and cosmetic results. Fixed and random-effect models were used to measure the pooled estimates.ResultsNineteen studies involving a total of 3432 participants were analysed (3 randomized clinical trials (RCTs) and 16 retrospective non-randomized studies). Pooled results showed significantly reduced postoperative complications (OR 0.54; 95 per cent c.i. 0.44 to 0.67; P < 0.00001). Pathological outcomes of NOSE were comparable to LAP with no significant difference noted in terms of resection margins (P > 0.05) and lymph node collection (weighted mean difference (WMD) -0.47; 95 per cent c.i. -0.94 to 0; P = 0.05). Pooled analysis demonstrated comparable long-term outcomes in terms of cancer recurrence (OR 0.94; 95 per cent c.i. 0.63 to 1.39; P = 0.75), 5-year disease-free survival (HR 0.97; 95 per cent c.i. 0.73 to 1.29; P = 0.83), and overall survival (HR 0.93, 95 per cent c.i. 0.58 to -1.51; P = 0.78). Finally, the NOSE group had decreased use of additional analgesia after surgery and earlier resumption of oral intake when compared with LAP (respectively OR 0.28; 95 per cent c.i. 0.20 to 0.37; P < 0.00001 and WMD -0.35; 95 per cent c.i. -0.54 to -0.15; P = 0.0005).ConclusionThis meta-analysis showed that in comparison with LAP, NOSE decreases severe postoperative morbidity while improving postoperative recovery without compromising oncological safety, but it is limited by the small number of RCTs performed in this field.

Project description:BackgroundNatural orifice specimen extraction surgeries (NOSES) have been applied to colorectal cancer (CRC). Different types of NOSES have been proposed. Traditional laparoscopic CRC surgeries (non-NOSES) have been widely adopted in clinical practice. Therefore, the safety and feasibility of NOSES could be clarified by comparing with non-NOSES.MethodsConsecutive cases who underwent NOSE or non-NOSE rectal surgeries were retrospectively collected at the Second Affiliated Hospital of Harbin Medical University between 1 January 2013 and 31 December 2018. Other inclusion criteria included patients with adenocarcinoma of the rectum within 15 cm of the anal verge, over the age of 18 and undergoing primary laparoscopic rectal resection. Patients who were lost to follow-up or had incomplete information were excluded. Basic characteristics including gender, tumor location, age, staging, treatment, and Body Mass Index (BMI) were analyzed. Short-term outcomes including comorbidities, intra-operative blood loss, hospital stay, gas exhaust time were compared between different NOSES and non-NOSES groups. Long-term outcomes including overall survival (OS) and disease-free survival (DFS) were also analyzed. Patients were followed-up during the inpatient period, at an outpatient clinic, or by phone call.ResultsA total of 196 NOSES cases and 243 non-NOSES cases were included. There was a sex difference between the two groups and other factors were comparable. Cases were divided into NOSES groups [including extra-abdominal resection (EVER), specimen extraction and extra-abdominal resection (EXER), and intra-abdominal resection and specimen extraction (IREX)] and non-NOSES groups. Differences in sex (P=0.016), BMI (with mean of 22.08, 22.00, 22.53, and 23.26 kg/m2, P=0.003), and staging (P=0.008) were observed between the four groups. There was a difference in the intra-operative blood loss between NOSES and non-NOSES groups (57.05±62.78, 52.65±68.19, 36.52±43.99 vs. 76.12±90.11 mL, P=0.002), in which NOSES groups had less blood loss. Furthermore, NOSES groups showed a better post-operative gas exhaust time (54.68±37.80, 45.06±24.69, 47.91±28.93 vs. 56.94±27.69 hours, P=0.012). NOSES groups also had fewer ileostomies (17 vs. 37, P=0.003). There was no difference in the long-term DFS and OS between the two groups.ConclusionsNOSES in rectal cancer showed better short-term outcomes and had comparable long-term outcomes compared with non-NOSE surgeries.

Project description:BackgroundGastric 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 summaryWe 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.ConclusionWe 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.

Dataset Information

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer.

Publications

International consensus on natural orifice specimen extraction surgery (NOSES) for colorectal cancer.

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