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Multicentre Prospective randomized trial of laparoscopic Radical resection of colorectal cancer with or without natural orifice specimen extraction

ABSTRACT: Interventions: experimental group:NOSES;control group:traditional laparoscopic-assisted Radical resection Primary outcome(s): Early (30 days) complication rate and mortality Study Design: Parallel

DISEASE(S): Colorectal Cancer

PROVIDER: 2699393 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:BACKGROUND:Natural 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. METHODS:MEDLINE (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. RESULTS:Ten 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. CONCLUSIONS:The 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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Multicentre Prospective randomized trial of laparoscopic Radical resection of colorectal cancer with or without natural orifice specimen extraction

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