Abstract
Aim The aims of this study were to compare the short-term outcomes of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery (CLAPS) for colorectal tumours and to evaluate the safety and feasibility of NOSES in colorectal resection. Methods A literature review was performed on the PubMed, Cochrane Library, and Embase databases up to March 2019. Papers conforming to the inclusion criteria were used for further analysis. The short-term outcomes included intraoperative outcomes and postoperative recovery results. The weighted mean difference (WMD) was calculated for continuous outcomes and odds ratio (OR) for dichotomous results. Study quality was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS) or the 6-item Jadad scale. Results Eight studies comprising 686 patients met the inclusion criteria. Compared with CLAPS, NOSES had more advantages in terms of postoperative complications, postoperative pain, recovery of gastrointestinal function, duration of hospital stay, and cosmetic results. The lymph nodes harvested and intraoperative blood loss in NOSES were comparable with CLAPS; however, a prolonged operative time was observed in NOSES. Conclusions NOSES was shown to be a safe and viable alternative to CLAPS in colorectal oncology in terms of short-term results. Further long-term and randomized trials are required.
Highlights
Since it emerged in the 1990s, laparoscopic proctocolectomy has been widely used for the treatment of various colorectal diseases including tumours [1,2,3,4]
A systematic search of the articles comparing of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery (CLAPS) for colorectal tumours was performed on the PubMed (MEDLINE), Cochrane Library (CENTRAL) and Embase databases up to March 2019. e following main terms were used: “Colorectal Neoplasms,” “Rectal Neoplasms,” “Colonic Neoplasms,” “Laparoscopy,” “natural orifice specimen extraction,” “transvaginal specimen extraction,” “transanal specimen extraction,” “transrectal specimen extraction,” “transcolonic specimen extraction,” and “natural orifice transluminal endoscopic surgery.” e search strategy of Embase was presented in S1 Text. ere were some distinctions in the specific search strategy used between different databases
Studies had to meet the following criteria: (1) NOSES was compared with CLAPS for colorectal tumour; (2) radical resection was performed with lymph node results; (3) at least 2 outcomes of interest were reported and characteristic baselines were comparable; (4) the most comprehensive research was recruited when overlapping researches were found by the same team; and (5) full text was available in English
Summary
Since it emerged in the 1990s, laparoscopic proctocolectomy has been widely used for the treatment of various colorectal diseases including tumours [1,2,3,4]. Because of the additional 5-6 cm incision, incision-related complications such as postoperative pain, incision infection, abdominal wall scar, and even incision hernia are problematic [7,8,9,10]. To mitigate these complications, a novel, minimally invasive surgery known as natural orifice specimen extraction surgery (NOSES) has been increasingly used worldwide [11]. Compared with CLAPS, the main features of NOSES in colorectal surgery are complete intraperitoneal anastomosis and specimen extraction from natural orifice [14,15,16,17]. Compared with CLAPS, the main features of NOSES in colorectal surgery are complete intraperitoneal anastomosis and specimen extraction from natural orifice [14,15,16,17]. is innovative technique is regarded as a step towards minimally invasive surgery
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