Effects of everting resection natural orifice specimen extraction surgery for colorectal cancer on postoperative function of patients / 肿瘤研究与临床

ABSTRACT

Objective:To investigate the effect of everting resection natural orifice specimen extraction surgery (NOSES) on postoperative function in patients with colorectal cancer.Methods:The clinical data of 78 patients with colorectal cancer treated in Chongqing Bishan District People's Hospital from June 2019 to June 2020 were retrospectively analyzed. According to the selected surgical methods, they were divided into the study group (45 cases) and the control group (33 cases). The control group underwent traditional laparoscopic radical resection of colorectal cancer, and the study group underwent everting resection NOSES. Perioperative indicators such as intraoperative bleeding, operation time, postoperative exhaust time and hospitalization time were observed in the two groups. Anal function indicators [anal constriction pressure, fecal incontinence severity score (Wexner score)], coagulation function indicators [activated partial thromboplastin time (APTT), prothrombin time (PT)], the levels of inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP)] and pain factors [nerve growth factor (NGF), prostaglandin E2 (PGE2), neuropeptide Y (NPY)] before and after operation were compared between the two groups.Results:There were no significant differences in intraoperative bleeding and operation time between the two groups ( t values were 1.30 and 0.56, both P > 0.05); the postoperative exhaust time and hospitalization time of the study group were shorter than those of the control group ( t values were 26.88 and 7.42, both P < 0.05). At 3 months after operation, the anal constriction pressure in the two groups was lower than that before operation [study group (177±10) mmHg (1 mmHg = 0.133 kPa) vs. (184±10) mmHg, t = 3.22, P < 0.001; control group (178±10) mmHg vs. (184±10) mmHg, t = 2.36, P = 0.020]; the Wexner score was higher than that before operation [study group (9.0±1.2) points vs. (7.9±1.2) points, t = 4.26, P < 0.001; control group (10.3±1.2) points vs. (7.9±1.2) points, t = 7.80, P < 0.001], and the Wexner score in the study group was lower than that in the control group ( t = 4.57, P < 0.001). At 1 day after operation, APTT and PT in the two groups were shorter than those before operation (all P < 0.05), and APTT and PT in the study group were shorter than those in the control group [APTT (26.2±2.2) s vs. (28.3±2.2) s, t = 4.23, P < 0.001; PT (9.34±0.17) s vs.(11.03±0.41) s, t = 24.93, P < 0.001]. At 1 day after operation, the levels of IL-6 and CRP in the two groups were higher than those before operation (all P < 0.05); the levels of IL-6 and CRP in the study group were lower than those in the control group [IL-6 (8.6± 2.2) ng/L vs. (17.2±3.1) ng/L, t = 14.26, P < 0.001; CRP (2.16±0.22) mg/L vs. (2.99±0.24) mg/L, t = 15.84, P < 0.001]. At 1 day after operation, the levels of NGF, PGE2 and NPY in the two groups were higher than those before operation (all P < 0.05), and the levels of NGF, PGE2 and NPY in the study group were lower than those in the control group [NGF (302±7) pg/ml vs. (319±8) pg/ml, t = 9.76, P < 0.001; PGE2 (189±4) ng/L vs. (196±5) ng/L, t = 6.56, P < 0.001; NPY (164±10) ng/L vs. (177±11) ng/L, t = 5.36, P < 0.001]. Conclusions:Everting resection NOSES can effectively shorten the postoperative exhaust time and hospitalization time of patients with colorectal cancer, have less impact on coagulation function and anal function, reduce the inflammatory reaction and the level of pain factors.