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Natural orifice specimen extraction surgery versus conventional laparoscopic-assisted resection for colorectal cancer in elderly patients: a propensity-score matching study

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Abstract

Whether natural orifice specimen extraction surgery (NOSES) could provide beneficial effects in treating elderly patients is still under debate. The aim of the study was to compare the clinical outcomes of transanal NOSES with conventional laparoscopic-assisted resection (LA) in elderly colorectal cancer (CRC) patients. A retrospective analysis from the Second Affiliated Hospital of Harbin Medical University between 2013 and 2017 was performed. Outcomes related to surgery, body image, quality of life, anal function and long-term survival were compared between the two groups with the propensity-score matching (PSM) method. After PSM, 78 patients were successfully compared. Patients with NOSES had faster gastrointestinal function recovery (P = 0.028), less postoperative complications (P = 0.025), lower pain scores on days 1, 3 and 5 after surgery (P < 0.001). The body image score (P < 0.001) and cosmetic score (P < 0.001) were significantly higher in the NOSES group than the LA group at 1 month after surgery. Patients with NOSES posed better global health status (P < 0.001), role function (P = 0.009), emotional function (P = 0.011) and social function (P = 0.011) at 3 months after surgery. Moreover, NOSES showed non inferiority in anal function 6 months after surgery. No significant difference could be found regarding to overall survival (OS), disease-free survival (DFS), local recurrence (LR) and distant metastasis (DM). In elderly CRC patients, NOSES harbored favorable postoperative outcomes, excellent cosmetic properties and better quality of life. Besides, anal function and long-term outcomes of NOSES can be sure for elderly patients.

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Availability of data and materials

The data which were used and/or analyzed during this study are available from the corresponding author on reasonable request.

Abbreviations

NOSES:

Natural orifice specimen extraction surgery

LA:

Laparoscopic-assisted resection

CRC:

Colorectal cancer

PSM:

Propensity-score matching

BMI:

Body mass index

ASA:

American Association of Anesthesiologists

LR:

Local recurrence (LR)

DM:

Distant metastasis

OS:

Overall survival

DFS:

Disease-free survival

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Acknowledgements

None.

Funding

This study was supported by the National Provincial Natural Fund (H2017016), the National Natural Science Foundation of China (81872034) and Wu Jieping Medical Foundation (320.6750.19092-41).

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China

    Hao Zhang, Hanqing Hu, Rui Huang, Zilong Guan, Mingyu Zheng, Chao Xu, Zhengliang Li, Yuliuming Wang, Weiyuan Zhang, Lei Yu, Yinghu Jin & Qingchao Tang

  2. Department of Colorectal Surgery, Zhejiang Cancer Hospital, Cancer Hospital of University of Chinese Academy of Sciences, Hangzhou, China

    Guiyu Wang

  3. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Xishan Wang

Authors
  1. Hao Zhang
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  2. Hanqing Hu
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  3. Rui Huang
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  4. Zilong Guan
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  5. Mingyu Zheng
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  6. Chao Xu
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  7. Zhengliang Li
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  8. Yuliuming Wang
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  9. Weiyuan Zhang
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  10. Lei Yu
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  11. Yinghu Jin
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  12. Qingchao Tang
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  13. Guiyu Wang
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Contributions

HZ, HQH, RH, GYW and XSW designed the study. HZ, ZLG, MYZ, CX, ZLL, YLMW and WYZ collected data. HZ, HQH, LY, YHJ, QCT, RH, GYW and XSW analyzed and interpreted data. HZ, GYW and XSW drafted the manuscript. HZ, ZLG, MYZ, CX, ZLL, YLMW, LY and WYZ critically revised the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Guiyu Wang or Xishan Wang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the Second Affiliated Hospital of Harbin Medical University, Zhejiang Cancer Hospital and Chinese Academy of Medical Sciences and Peking Union Medical College. The study adhered to World Medical Association’s Declaration of Helsinki for Ethical Human Research.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The informed consent was not required due to the retrospective nature of the study.

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Zhang, H., Hu, H., Huang, R. et al. Natural orifice specimen extraction surgery versus conventional laparoscopic-assisted resection for colorectal cancer in elderly patients: a propensity-score matching study. Updates Surg 74, 599–607 (2022). https://doi.org/10.1007/s13304-021-01143-y

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  • DOI: https://doi.org/10.1007/s13304-021-01143-y

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