Three-Port with Natural Orifice Specimen Extraction versus Conventional Laparoscopic Anterior Resection for Rectal-Sigmoid Cancer: A Matched Pair Analysis

Abstract

Background

The conventional laparoscopic colorectal surgery requires four or more ports to accomplish the laparoscopic dissection, and a mini-laparotomy to remove the specimen, which is a main cause of postoperative pain and incision complications, and compromise the cosmetic results. Reduced port surgery and natural orifice specimen extraction (NOSE) surgery hold the promise to overcome these drawbacks. This study planned to compare peri-operative outcomes of patients with rectal-sigmoid cancer undergoing three-port laparoscopic anterior resection with NOSE (three-port NOSE LAR) to those of patients receiving conventional LAR.

Methods

Twenty-five patients with rectal-sigmoid cancer underwent three-port NOSE LAR between December 2018 and October 2020. For comparison, 50 patients with rectal-sigmoid cancer underwent conventional LAR in the same period were matched. The peri-operative outcomes were compared.

Results

Operating time of three-port NOSE group was slightly longer than that of conventional group (135 min vs. 121 min, p = .147). The incision length of three-port NOSE group was shorter than that of conventional group (2.9 cm vs. 7.4 cm, p = .000). Complication rates in three-port NOSE group and conventional group were similar (12.0% vs. 20.0%, p = .524). The tumor size was smaller in three-port NOSE group than the conventional group (2.1 cm vs. 3.5 cm, p = .000). Pain score was lower in three-port NOSE group than the conventional group at postoperative day 1 (1.6 vs. 3.0, p = 0.045) and day 2 (0.2 vs. 2.1, p = .003). The BIQ score was significantly higher in the three-port NOSE group compared to the conventional group (42.9 ± 3.5 vs. 38.2 ± 2.5, p = .002).

Conclusions

Three-port NOSE LAR for rectal-sigmoid cancer is feasible and provides similar peri-operative outcomes compared to conventional LAR. It reduces postoperative pain and produces better cosmesis.

Keywords:

• rectal-sigmoid cancer
• natural orifice specimen extraction
• three-port
• laparoscopic surgery
• anterior resection

Disclosure statements

Haiyang Zhou, Anqi Wang, Hao Lu, Jia Wu, Jun Ying, Canping Ruan and Zhiqian Hu have no conflicts of interest or financial ties to disclose. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Authors’ contributions

Dr Zhou had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Zhou, Ruan, and Hu. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Zhou, Wang, Lu, and Wu. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Wang, Lu, and Wu. Video clips: Wang, Zhou. Obtained funding: Zhou. Supervision: Zhou, Ruan, and Hu.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [No. 81571827], Shanghai Rising-Star Program [No. 17QA1405600], Shanghai Excellent Young Medical Talents Program [No. 2017YQ006].