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Meta-analysis of natural orifice specimen extraction versus conventional laparoscopy for colorectal cancer

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Objective

To compare natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic (LAP) surgery in treating colorectal cancer.

Methods

The present authors conducted a systematic search in the PubMed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs), prospective nonrandomized studies, and retrospective studies up to May 2019. We used postoperative complications as the main endpoints, and used hospital stay, time to first flatus, operative time, postoperative pain, cosmetic result, wound infections, and oncological outcomes as the secondary endpoints. Subgroup analyses were conducted according to the different specimen extraction sites (transanal and transvaginal). A sensitivity analysis was carried out to evaluate the reliability of the outcomes. RevMan5.3 software was used for statistical analysis.

Result

Twelve studies (one RCT, ten retrospective studies, and one prospective nonrandomized study) involving a total of 1437 patients (NOSES group 665 patients and LAP surgery group 772 patients) were included. Meta-analysis showed that compared with LAP surgery, NOSES resulted in a shorter hospital stay (WMD = −0.79 days; 95% CI −1.17 to −0.42; P < 0.001; P = 0.02), a shorter time to first flatus (WMD = −0.58 days; 95% CI −0.75 to −0.40; P < 0.001), less postoperative pain (WMD = −1.51; 95% CI −1.99 to −1.04; P < 0.001), a better cosmetic result (WMD = 1.37; 95% CI 0.59 to 2.14; P < 0.001), and fewer wound infections (OR = 0.13; 95% CI 0.05 to 0.35; P < 0.001) and postoperative complications (OR = 0.48; 95% CI 0.36 to 0.65; P < 0.001). Oncological outcomes did not differ between the two groups, while the operative time (WMD = 13.95 min; 95% CI 4.55 to 23.35; P = 0.004) was longer in the NOSES group.

Conclusion

The present systematic meta-analysis is an attempt to assess the impact of NOSES, namely, its oncological outcomes and surgical safety in colorectal cancer patients. Pooled comparisons revealed that NOSES was superior to LAP surgery in terms of postoperative morbidity, postoperative pain, hospital stay, the time to first flatus, cosmetic results, and wound infections; however, NOSES was associated with a longer operative time. Considering the abovementioned limitations and the very low level of evidence of the comparisons, further RCTs are required to verify the results of our study.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Not applicable.

Funding

This study was supported by the Fujian Province teaching reform project (grant no. FBJG20190063), the Training Project of Young Talents in the Health System of Fujian Province (grant no. 2019-2-20), and the Fujian Medical University Key teaching reform project (grant no. Y19001).

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Author notes

  1. Jiajing Lin and Suyong Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang, Fuzhou, Fujian, 350004, People’s Republic of China

    Jiajing Lin, Suyong Lin, Zhihua Chen, Bingqiu Zheng, Yilin Lin, Yan Zheng, Yisu Liu & Shao Qin Chen

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  1. Jiajing Lin
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Contributions

SQC designed the study, obtained funding, analyzed the data, and revised the manuscript. JJL drafted the manuscript and supervised the study. SQC was a supporter of the funding (grant no. FBJG20190063) and participating in the drafting and subsequent revision of the manuscript. SYL, ZHC, and BQZ collected and analyzed the data. All authors read and approved the final manuscript.

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Correspondence to Shao Qin Chen.

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Lin, J., Lin, S., Chen, Z. et al. Meta-analysis of natural orifice specimen extraction versus conventional laparoscopy for colorectal cancer. Langenbecks Arch Surg 406, 283–299 (2021). https://doi.org/10.1007/s00423-020-01934-8

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