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【Objective】 To explore the feasibility, safety and clinical application value of laparoscopic radical rectal cancer surgery with natural orifice specimen extraction (NOSE) by comparing the postoperative pathological data, surgery-related variables and postoperative recovery between laparoscopic radical rectal cancer surgery with NOSE and laparoscopic-assisted radical rectal cancer surgery. 【Methods】 A retrospective analysis was conducted on 74 patients who underwent radical rectal cancer surgery with anus preservation in the Department of General Surgery of The First Affiliated Hospital of Xi’an Jiaotong University from July 2017 to April 2022. Among them, 38 cases underwent surgery with specimen extraction through an abdominal auxiliary incision (auxiliary incision group), and 36 cases underwent surgery with specimen extraction through a natural orifice (NOSES group). The differences in the efficacy of the two surgeries were evaluated by comparing the postoperative pathological data, surgical variables, and postoperative recovery of the two groups. 【Results】 There were no statistically significant differences in general data and postoperative pathological data between the two groups (all P>0.05). The NOSES group exhibited significantly shorter operative time, time to first flatus, time to first oral intake postoperatively, and postoperative hospital stay compared to the auxiliary incision group (all P0.05). 【Conclusion】 Laparoscopic surgery with NOSE for rectal cancer is safe and feasible with minimally invasive and accelerated recovery, which is worth promoting and applying in clinical practice.
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Objective:To compare and analyze the efficacy of supraumbilical longitudinal auxiliary incision and left lower abdominal oblique auxiliary incision during laparoscopic radical resection of rectal cancer.Methods:The data of 196 patients with rectal cancer treated in the Second Affiliated Hospital of Xiamen medical college from January 2015 to December 2020 were analyzed retrospectively. Different abdominal auxiliary incisions were used for grouping. The control group (101 cases) used the oblique auxiliary incision of the left lower abdomen, and the observation group (95 cases) used the longitudinal auxiliary incision of the upper umbilical cord. The intraoperative indicators (operative time, intraoperative blood loss, auxiliary incision length, distance between anastomotic teeth and dentate line), postoperative indicators (first postoperative exhaust time, postoperative pain score, fluid intake time, first out of bed time and hospital stay) and operative complications between the two groups were compared.Results:The first postoperative exhaust time ((56.8±4.3) h vs. (70.3±5.8) h, t=4.796) and the first postoperative out of bed time ((38.81±2.04) h vs. (47.93±2.63) h, t=5.113) in the observation group were significantly shorter than those in the control group, and the pain scores at 24 hours ((2.01±0.22) vs.(2.43±0.40), t=5.882) and 48 hours pain score ((2.23±0.44) vs. (3.14±0.72), t=6.58) after operation were significantly lower than those in the control group (all P<0.05). The incidence of incision hernia in the observation group was significantly lower than that in the control group (5.3% (5/95) vs.9.9% (10/101), χ 2=4.29)( P<0.05). Conclusion:Compared with the left lower abdominal oblique auxiliary incision,the supraumbilical longitudinal auxiliary incision in laparoscopic radical resection of rectal cancer can not only significantly reduce the postoperative pain scores and recover the postoperative intestinal function as soon as possible, but also significantly reduce the incidence of postoperative incision hernia.
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Objective@#To introduce a new technique of protective ostomy using the specimen extraction auxiliary incision following laparoscopic low anterior resection for rectal cancer, and to compare the pros and cons of loop ileostomy (LI) and loop transverse colostomy (LTC).@*Methods@#A retrospective cohort study was performed. The data of patients who underwent laparoscopic low anterior resection for rectal cancer and ostomy using the auxiliary incision in Peking Union Medical College Hospital from January 2010 to December 2017 were retrospectively analyzed. Inclusion criteria: (1) patient underwent neoadjuvant chemoradiotherapy before operation; (2) patient was classified as tumor stage II or III; (3) patient was followed up and underwent stoma closure at our center; (4) ostomy was performed through specimen extraction incision. Patients with multiple gastrointestinal carcinomas or inflammatory bowel disease were excluded. Two hundred and eight patients were included in the study and divided into the LI group (n=86) and LTC group (n=122). The operation parameters and postoperative complications were compared between the two groups.@*Results@#There were 135 males and 73 females (1.85∶1.00). Mean age of the 208 patients was (59.6±11.6) years (range 29-85 years). There were no significant differences between LI and LTC groups in baseline data (all P>0.05). All of the patients completed surgery successfully. The severe complication rate after ostomy was 2.9% (6/208). In the fecal diversion period, LI group showed significantly faster defecation [(1.6±1.0) days vs. (2.2±1.9) days, t=-2.918, P=0.004] and lower incidence of parastomal hernia [8.1% (7/86) vs. 19.7% (24/122), χ2=5.290, P=0.021], but higher incidence of peristomal dermatitis [18.6% (16/86) vs. 4.9% (6/122), χ2=9.990, P=0.002] as compared to LTC group. The incidence of renal insufficiency was lower in LTC group, though the difference was not significant [4.9% (6/122) vs. 10.5% (9/86), χ2=2.320, P=0.128]. The severe complication rate after stoma closure was 1.9% (4/208). In the stoma closure period, a significantly higher incidence of wound infection was noted in LTC group [18.0% (22/122) vs. 4.7% (4/86), χ2=8.258, P=0.004]. There were no significant differences between the two groups in the incidence of anastomotic leakage, stenosis, and incisional hernia (all P>0.05). All complications were improved after treatment.@*Conclusions@#Both LI and LTC through auxiliary incision following laparoscopic low anterior resection for rectal cancer are safe and feasible. LTC is an optional method for those patients with sensitive skin.