From January 2017 to December 2021, patients underwent laparoscopic radical resection in treatment for upper rectal cancer and sigmoid colon cancer at the National Cancer Center were reviewed. Patients who underwent laparoscopic surgery with natural orifice extraction were assigned to NOSES group while patients who performed conventional laparoscopic surgery with abdominal auxiliary incision were assigned to LAP group. The inclusion criteria were as follows: (1) aged between 18 and 75 years; (2) cT stage 1–3 (3) without distant metastasis. The exclusion criteria were: (1) complicated with other malignant tumors (2) emergency surgery for acute intestinal obstruction, perforation or bleeding. Finally, 186 patients who underwent NOSES and 274 who underwent LAP were enrolled. Propensity score matching (PSM) was used to balance the baseline data between the two groups. Propensity scores were matched 1:1 based on age, gender, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, preoperative chemotherapy, tumor location, tumor differentiation, T stage, N stage, and tumor size. Finally, 144 patients were assigned to the NOSES group while 144 patients were assigned to the LAP group (Figure 1 ).
Preoperative assessment for all patients included laboratory examination, colonoscopy with biopsy, abdominal CT scan and pelvic magnetic resonance imaging. Tumor staging was evaluated according to the American Joint Committee on Cancer (AJCC, eighth edition) staging system. Patients with clinical stage II and III received preoperative chemoradiotherapy followed by surgery 6 weeks later. All patients received mechanical bowel preparation before surgery, and intravenous antibiotic profilaxis were administered during perioperative period. Postoperatively, patient-controlled analgesia (PCA) was administered to all patients for pain management, and additional nonsteroidal and opioid analgesics were administered intravenously as required. Pain scores were assessed once daily with a validated visual analogue scale (VAS), ranging from 0 to 10, with 0 representing no pain and 10 representing the worst conceivable pain. All patients signed the written informed consent and complied with the Declaration of Helsinki. This retrospective study was approved by the Institutional Review Board Committee of the Cancer Hospital at the Chinese Academy of Medical Sciences (No. 18-015/1617).
Preoperative assessment for all patients included laboratory examination, colonoscopy with biopsy, abdominal CT scan and pelvic magnetic resonance imaging. Tumor staging was evaluated according to the American Joint Committee on Cancer (AJCC, eighth edition) staging system. Patients with clinical stage II and III received preoperative chemoradiotherapy followed by surgery 6 weeks later. All patients received mechanical bowel preparation before surgery, and intravenous antibiotic profilaxis were administered during perioperative period. Postoperatively, patient-controlled analgesia (PCA) was administered to all patients for pain management, and additional nonsteroidal and opioid analgesics were administered intravenously as required. Pain scores were assessed once daily with a validated visual analogue scale (VAS), ranging from 0 to 10, with 0 representing no pain and 10 representing the worst conceivable pain. All patients signed the written informed consent and complied with the Declaration of Helsinki. This retrospective study was approved by the Institutional Review Board Committee of the Cancer Hospital at the Chinese Academy of Medical Sciences (No. 18-015/1617).
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