Long-Term Outcome Comparison Between Two Specimen Extraction Approaches for Middle Rectum Cancer: A Retrospective Study

Objective. There are few studies comparing the long-term results of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic-assisted resection (LA) in the treatment of middle rectal cancer. This retrospective analysis aimed to evaluate the reliability of NOSES. Method. From January 2013 to December 2017, all patients diagnosed with median rectal cancer in our hospital who underwent NOSES and LA were enrolled. We used propensity-score matching (PSM) to balance baseline data between the NOSES group and the laparoscopic group. The primary endpoint was overall survival (OS) and disease-free survival (DFS). We used the Kaplan-Meier method to estimate OS and DFS. Student's t-test was used to analyze the difference of continuous data. Categorical data were compared using the Kruskal-Wallis test or Fisher's exact test. Results. After PSM, 38 patients were included in each group. We found that surgical bleeding volume in the NOSES group was considerably lower than that in the LA group (49.5 +/- 47.5 mL vs. 86.3 +/- 83.5 mL, P = .01). From the short-term results, the first flatus and regular diet time in the NOSES group were shorter than those in the LA group (41.3 +/- 25.2 vs. 54.0 +/- 19.2 hours, P < .01 and 63.9 +/- 42.6 hours vs. 105.1 +/- 66.8 hours, P < .01, respectively). Long-term OS and DFS were not different between the groups. Conclusion. Therefore, NOSES is a reliable technique for middle rectal cancer treatment. Short-term outcomes are pointedly better than LA, while the two surgical approaches did not differ in the long-term outcomes or complication rate.

Automated summary

In this retrospective analysis, the reliability of natural orifice specimen extraction surgery (NOSES) for middle rectal cancer treatment was evaluated through comparing it with conventional laparoscopic-assisted resection (LA). The short-term outcomes of NOSES, including surgical bleeding volume, time to first flatus, and time to regular diet, were significantly better than those of LA, while the long-term overall survival (OS) and disease-free survival (DFS) did not differ between the two surgical approaches.