Clinical efficacy analysis of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery (CLS) in the treatment of rectal cancer: a single-center retrospective analysis - Report - MDSpire
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Clinical efficacy analysis of natural orifice specimen extraction surgery (NOSES) and conventional laparoscopic surgery (CLS) in the treatment of rectal cancer: a single-center retrospective analysis
Comparative Study of NOSES Versus CLS for Rectal Cancer Treatment
Overview
This retrospective study compared natural orifice specimen extraction surgery (NOSES) with conventional laparoscopic surgery (CLS) in rectal cancer patients. After propensity score matching, NOSES demonstrated advantages in postoperative pain, inflammatory markers, and recovery times without increasing complications.
Background
Colorectal cancer is a leading cause of cancer incidence and mortality worldwide, necessitating effective surgical treatments. Minimally invasive techniques like NOSES aim to improve patient quality of life by reducing postoperative pain and wound-related complications. However, NOSES requires specialized surgical skills and has not been widely adopted. This study evaluates the clinical efficacy of NOSES compared to CLS by analyzing perioperative outcomes and complications in rectal cancer patients.
Data Highlights
Parameter
NOSES (n=24)
CLS (n=24, matched)
P Value
Surgical Time (min)
Not specified
Not specified
NS
Blood Loss (mL)
Not specified
Not specified
NS
WBC Count (post-op)
Lower
Higher
<0.05
CRP (post-op)
Lower
Higher
<0.05
VAS Score (Day 1, 3, 7)
Lower
Higher
<0.05
Time to First Flatus (days)
Shorter
Longer
<0.05
Postoperative Hospital Stay (days)
Shorter
Longer
<0.05
Hospitalization Costs
Comparable
Comparable
NS
Complications
Similar incidence
Similar incidence
NS
Additional Analgesia
Less frequent
More frequent
<0.05
Key Findings
NOSES patients experienced significantly lower postoperative pain as measured by VAS scores on days 1, 3, and 7.
Inflammatory markers including white blood cell count and C-reactive protein were lower postoperatively in the NOSES group, indicating reduced surgical stress.
Time to first flatus and length of postoperative hospital stay were significantly shorter in the NOSES group, suggesting faster recovery.
There was no significant difference in surgical time, blood loss, hospitalization costs, or complication rates between NOSES and CLS groups.
Patients undergoing NOSES required less additional analgesia postoperatively compared to CLS patients.
Clinical Implications
NOSES offers a minimally invasive alternative to conventional laparoscopic surgery for rectal cancer with benefits including reduced postoperative pain and faster gastrointestinal recovery. Surgeons should consider NOSES for eligible patients to enhance recovery while maintaining comparable safety and cost profiles. Adequate training in NOSES techniques is essential due to its technical complexity.
Conclusion
This study supports NOSES as a safe and effective surgical approach for rectal cancer that improves postoperative recovery and pain management without increasing complications or costs compared to CLS.
References
Global Cancer Statistics 2020 -- Colorectal Cancer Incidence and Mortality
Chinese Expert Consensus on NOSES for Colorectal Cancer 2023
