Trans-rectal natural orifice specimen extraction (NOSE) during laparoscopic anterior resection: Chinese experience with a novel method

Abstract Background: To introduce a novel method for double stapling technique in colorectal anastomosis during laparoscopic anterior resection of upper rectal or sigmoid colon cancer with trans-rectal natural orifice specimen extraction (NOSE). Methods: From June 2015 and May 2016, patients with upper-rectal or sigmoid colon cancer who received treatment in Shanghai East Hospital were enrolled. Preoperative and postoperative clinical variables were analyzed and compared between groups. Postoperative pain was analyzed utilizing a visual analog scale (VAS). Postoperative overall survival was analyzed using a K-M curve. Results: A total of 99 colorectal cancer cases were randomly divided into NOSE with novel method group (NOSE, n=48) and conventional laparoscopic group (non-NOSE, n=51). No statistically significant differences in preoperative demographics of the patients as sex, age, body mass index were found among the groups. The NOSE group had the longer operation time, but less blood loss than the non-NOSE group. The NOSE group had no abdominal incision and the lower postoperative VAS score. The time for intestinal function recovery and the length of hospital stay (LOS) was statistically significantly different, with the non-NOSE group having the longer time. The incidence of postoperative complications was lower in NOSE group (5/48, 10.4%) than in the non-NOSE group (8/51, 15.7%), the difference was statistically significant. The K-M survival curve showed no statistically significant difference in the disease free survival rate between the NOSE group and non-NOSE group. Conclusion: NOSE with novel method is safe and feasible to use in patients having colorectal cancer. Compared with traditional laparoscopic surgery, the postoperative complication rates of NOSE surgery were lower with an improved short-term clinical recovery.