Abstract
Background
Conventional laparoscopic right hemicolectomy (LRH) involves making an abdominal incision to remove the specimen and perform the anastomosis. Totally laparoscopic right hemicolectomy with natural orifice specimen extraction (NOSE) may lead to better outcomes compared to LRH.
Study design
Forty consecutive female patients total were reviewed: 20 LRH and 20 NOSE. The two groups were matched for sex, age, race, American Society of Anesthesiologist score, benign and malignant disease, tumor stage, lymph node number, tumor size, specimen length, body mass index, previous abdominal surgeries, and comorbidities.
Results
The two groups were comparable for all categories. Follow-up was available on all patients (100 %). The mean follow-up was 38.93 months (range 15–63 months). There was no difference between postoperative pain score between the two groups on postoperative day (POD) 1, POD 2, and POD day 14 (p = 0.571), (p = 0.861), (p = 0.688), respectively. There was no difference in the postoperative in-hospital morphine equivalents (p = 0.963). The NOSE group had no postoperative hernia formation or wound infections compared to the LRH, however, the difference was not significant (p = 0.439) and (p = 0.267), respectively. There was no difference in postoperative ileus (p = 0.192), septic complications (p = 1.000), readmission rate (p = 0.394), time interval for postoperative chemotherapy (p = 0.645), SDS (p = 0.446) or QLI (p = 0.175). There was no difference in length of hospital stay with 5.3 days for the LRH group and 7.7 days for the NOSE group (p = 0.183). The NOSE group had statistically significant better cosmetic scores (p = 0.018).
Conclusion
NOSE is comparable LRH with regard to postoperative outcomes and quality of life. NOSE is safe and maintains strict oncologic standards. NOSE is associated with a better cosmetic outcome compared to LRH.
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References
Fowler DL, White SA (1991) Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc 1:183–188
Cooperman AM, Katz V, Zimmon D, Botero G (1991) Laparoscopic colon resection: a case report. J Laparoendosc Surg 1:221–224
Liberman MA, Phillips FH, Carroll BJ et al (1996) Laparoscopic colectomy vs traditional colectomy for diverticulitis. Surg Endosc 10:15–18
Kohler L, Rixen D, Troidl H (1998) Laparoscopic colorectal resection for diverticulitis. Int J Colorectal Dis 13:43–47
Senagore AJ, Duepree HJ, Delaney CP et al (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease. Dis Colon Rectum 45:485–490
Young Fadok TM, Long KH, McConnell EJ et al (2001) Advantages of laparoscopic resection for ileocolic Crohn’s disease. Surg Endosc 15:450–454
Duepree HJ, Senagore AJ, Delaney CP et al (2002) Advantages of laparoscopic resection for ileocecal Crohn’s disease. Dis Colon Rectum 45:605–610
Bergamaschi R, Arnaud JP (1997) Immediately recognizable benefits and drawbacks after laparoscopic colon resection for benign disease. Surg Endosc 11:802–804
Tomita H, Marcello PW, Milsom JW (1999) Laparoscopic surgery of the Colon and Rectum. World J Surg 23:397–405
Falk PM, Beart RW, Wexner SD et al (1993) Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 36:28–34
Philipson BM, Bokey EL, Moore JWE et al (1997) Cost of open versus laparoscopically assisted right hemicolectomy for cancer. World J Surg 21:214–217
Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy- assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASSIC trial): multicenter, randomized controlled trial. Lancet 365:1718–1726
Colon Cancer Laparoscopic or Open Resection Study Group (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial. Lancet Oncol 6:477–484
Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study (2007) Group. Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303
Tong DKH, Fan JKM, Law W-L (2008) Outcome of laparoscopic colorectal resection. Surgeon 6:357–360
Colon Cancer Laparoscopic or Open Resection Study Group (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol 10:44–52
Kennedy GD, Heise C, Rajamanickam V et al (2009) Laparoscopy decreases postoperative complication rates after abdominal colectomy. Ann Surg 249:596–601
Guller U, Jain N, Hervey S et al (2003) Laparoscopic versus open colectomy. Arch Surg 138:1179–1186
Veldkamp R, Gholghesaei M, Bonjer HJ et al (2004) Laparoscopic resection of colon cancer. Surg Endosc 18:1163–1185
Schwenk W, Haase O, Neudecker JJ et al (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2:CD003145. doi:10.1002/14651858.CD003145.pub2.
Noel JK, Fahrback K, Estok R et al (2007) Minimally invasive colorectal resection outcomes: short-term comparison with open procedures. J Am Coll Surg 204:291–305
Poon JT, Law W-L, Wong IW et al (2009) Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg 249:77–81
Winslow ER, Fleshman JW, Birnbaum EH et al (2002) Wound complications of laparoscopic vs open colectomy. Surg Endosc 16:1420–1425
Ihedioha U, Mackay G, Leung E et al (2008) Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection. Surg Endosc 22:689–692
Singh R, Omiccioli A, Hegge S et al (2008) Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? Surg Endosc 22:596–600
McKenzie S, Baek JH, Wakabayashi M et al (2010) Totally laparoscopic right colectomy with transvaginal specimen extraction: the authors’ initial institutional experience. Surg Endosc 24:2048–2052
Park JS, Choi GS, Lim KH et al (2010) Clinical outcome oflaparoscopic right hemicolectomy with transvaginal resection, anastomosis, and retrieval of specimen. Dis Colon Rectum 53:1473–1479
Awad Z, Qureshi I, Seibel B et al (2011) Laparoscopic right hemicolectomy with transvaginal colon extraction using a laparoscopic posterior colpotomy: a 2-year series from a single institution. Surg Laparosc Endosc Percutan Tech 21:403–408
Leroy J, Costantino F, Cahill RA, D’Agostino J, Morales A, Mutter D, Marescaux J (2011) Laparoscopic resection with transanal specimen extraction for sigmoid diverticulitis. Br J Surg 98:1327–1334
Nishimura A et al (2011) Totally laparoscopic sigmoid colectomy with transanal specimen. Extract Surg Endosc 25:3459–3463
McCorkle R, Quint-Benoliel J (1983) Symptom distress, current concerns and mood disturbance after diagnosis of life-threatening disease. Soc Sci Med 17:431–438
Spitzer WO, Dobson AJ, Hall J et al (1981) Measuring the quality of life of cancer patients. J Chronic Dis 34:585–597
Park JS, Choi GS, Kim HJ et al (2011) Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy. Br J Surg 98:710–715
Franklin ME Jr, Liang S, Russek K (2013) Natural orifice specimen extraction in laparoscopic colorectal surgery: transanal and transvaginal approaches. Tech Coloproctol 17(Suppl 1):S63–S67
Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr (2004) Laparoscopic-assisted versus open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 14:329–334
Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J (2006) Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 93:921–928
Bonjer HJ, Hop WC, Nelson H et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303
Wilson JI, Dogiparthi KK, Hebblethwaite N, Clarke MD (2007) Laparoscopic right hemicolectomy with posterior colpotomy for transvaginal specimen retrieval. Colorectal Dis 9(7):662
Lakshman N, Chang R, Ho Y (2006) Laparoscopic combined rectal anterior resection and total hysterectomy with bilateral salpingo-oophorectomy. Tech Coloproctol 10(4):350–352
Torres RA, Orban RD, Tocaimaza L, Vallejos Pereira G, Arévalo JR (2012) Transvaginal specimen extraction after laparoscopic colectomy. World J Surg 36(7):1699–1702
Hwang JH, Lee JK, Lee NW, Lee KW (2011) Vaginal cuff closure: a comparison between the vaginal route and laparoscopic suture in patients undergoing total laparoscopic hysterectomy. Gynecol Obstet Invest 71(3):163–169
Shen CC, Hsu TY, Huang FJ, Roan CJ, Weng HH, Chang HW, Chang SY (2002) Comparison of one- and two-layer vaginal cuff closure and open vaginal cuff during laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc 9(4):474–480
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Ziad T. Awad and Reginald Griffin have no conflict of interest or financial ties to disclose.
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Awad, Z.T., Griffin, R. Laparoscopic right hemicolectomy: a comparison of natural orifice versus transabdominal specimen extraction. Surg Endosc 28, 2871–2876 (2014). https://doi.org/10.1007/s00464-014-3540-8
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DOI: https://doi.org/10.1007/s00464-014-3540-8