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Totally laparoscopic gastrectomy with natural orifice (vagina) specimen extraction in gastric cancer: Introduction of a new technique.

ABSTRACT: Radical excision by surgery is the main treatment method for gastric cancer and as the surgery develops, the laparoscopic treatment effect on gastric cancer is gradually being verified. The totally laparoscopic gastrectomy (TLG) with natural orifice specimen extraction surgery (NOSES) for gastric cancer has attracted people's attention by avoiding abdominal incision and further reducing surgical injury and provides ideas for the further development of minimally invasive surgical treatment on the basis of laparoscopy. Surgical technique of TLG with natural orifice (vagina) specimen extraction is detailed in the text. We have employed NOSES in 4 cases of TLG in the past year. The visual analogue scale score was low, and all patients had no complications during and after the operation. No recurrence or metastasis was found in the short-term follow-up. TLG with NOSES is feasible and has many advantages such as aesthetics, light post-operative pain.

SUBMITTER: Dong C

PROVIDER: S-EPMC9306110 | biostudies-literature |

REPOSITORIES: biostudies-literature

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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.

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 surgery is a novel technique of minimally invasive surgery. The purpose of this study was to compare the safety of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) and abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectum tumors.MethodsMEDLINE (PubMed), Embase, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, and ClinicalTrials databases were systematically searched for related articles up to August 2019. The primary outcomes included postoperative complications (overall postoperative complication, incision-related complication, anastomotic fistula, and severe complication) and pathologic results (lymph nodes harvested, proximal resection margin, and distal resection edge). The statistical analysis was performed on STATA 12.0 software.ResultsTen studies comprising 1787 patients were used for meta-analysis. Compared with AISE-LAR, NOSE-LAR had more advantages in terms of overall postoperative complication (odds ratio (OR) = 0.65 (95% CI, 0.46 to 0.90; P = 0.01)), incision-related complication (OR = 0.13 (95% CI, 0.05 to 0.35; P < 0.01)), distal resection edge (weighted mean difference (WMD) = 0.17 cm (95% CI, 0.02 to 0.33 cm; P = 0.02)), recovery of gastrointestinal function (WMD = - 0.38 day (95% CI, - 0.70 to - 0.06 day; P = 0.02 )), pain scores in postoperative day 1 (WMD = - 1.64 (95% CI, - 2.31 to - 0.98; P < 0.01)), additional analgesics usage (OR = 0.21 (95% CI, 0.11 to 0.40; P < 0.01)) and hospital stay (WMD = - 0.71 day (95% CI, - 1.10 to - 0.32 day; P < 0.01)), while the operation time of NOSE-LAR was prolonged (WMD = 7.4 min (95% CI, 0.17 to 14.64 min; P = 0.04)). The anastomotic fistula, severe complication, lymph nodes harvested, proximal resection margin, intraoperative blood loss, and long-term outcomes in NOSE-LAR were comparable with AISE-LAR.ConclusionsThe safety of NOSE-LAR was demonstrated, and it could be an alternative to conventional surgery in laparoscopic anterior resection for sigmoid and rectal tumors. However, further randomized and multi-center trials are required.

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Totally laparoscopic gastrectomy with natural orifice (vagina) specimen extraction in gastric cancer: Introduction of a new technique.

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