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The safety and efficacy of laparoscopic surgery versus laparoscopic NOSE for sigmoid and rectal cancer

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Abstract

Background

Laparoscopic surgery with natural orifice specimen extraction (La-NOSE) is being performed more frequently for the minimally invasive management of sigmoid and rectal cancer. The objective of this meta-analysis was to compare the clinical and oncological safety and efficacy of La-NOSE versus conventional laparoscopy (CL).

Methods

A search of the PubMed, Web of Science, and Cochrane databases was performed for studies that compared clinical or oncological outcomes of conventional laparoscopic resection using NOSE with conventional laparoscopic resection for sigmoid and rectal cancer.

Results

Compared with CL group, the length of hospital stay and the pain score on the first day were shorter in the La-Nose group. The La-NOSE group had a lower incidence of total perioperative complications (OR 0.46; 95% CI [0.32 to 0.66]; I2 = 0%; P < 0.0001) and a lower incidence of surgical site infections (SSIs) (OR 0.11; 95% CI [0.04 to 0.29]; I2 = 0%; P < 0.0001) than the CL group, while the anastomotic leakage showed no significant difference between the La-Nose group and the CL group (P = 0.19). 5-year disease-free survival (DFS) and 5-year overall survival (OS) were no significant difference between the La-Nose group and the CL group (P = 0.43, P = 0.40, respectively).

Conclusions

La-NOSE can achieve oncological and surgical safety comparable to that of CL for patients with sigmoid and rectal cancer. La-NOSE in patients was associated with a shorter hospital stay, shorter time to first flatus or defecation, less postoperative pain, and fewer surgical site infections (SSIs) and total perioperative complications. In general, the operative time in La-NOSE was longer than that in CL. The long-term oncological efficacy of La-NOSE seems to be equivalent to that of CL.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

HR:

Hazard ratio

LA:

Conventional laparoscopic surgery

NOS:

Newcastle–Ottawa Scale

NOSE:

Natural orifice specimen extraction

OR:

Odds ratio

PNT:

Prospective non-randomized trial

RCT:

Randomized controlled trial

RT:

Retrospective trial

SD:

Standard deviation

SSI:

Surgery section infection

MD:

Mean difference

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Authors and Affiliations

  1. Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China

    Shu Xu, Kuijie Liu & Hongliang Yao

  2. National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China

    Xi Chen

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Correspondence to Hongliang Yao.

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Shu Xu, Xi Chen, Kuijie Liu, and Hongliang Yao have no conflicts of interest and financial ties to disclose.

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Xu, S., Liu, K., Chen, X. et al. The safety and efficacy of laparoscopic surgery versus laparoscopic NOSE for sigmoid and rectal cancer. Surg Endosc 36, 222–235 (2022). https://doi.org/10.1007/s00464-020-08260-6

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