Comparison of short-term and survival outcomes for transanal natural orifice specimen extraction with conventional mini-laparotomy after laparoscopic anterior resection for colorectal cancer

Figures & data

Table 1 Patient characteristics

Characteristic	NOSE (n=52)	LAP (n=52)	p-value
Age, year (mean ± SD)	55.6±10.4	57.0±10.7	0.468
Gender			1.000
Male	27	27
Female	25	25
BMI, kg/m^2 (mean ± SD)	22.7±2.7	23.1±2.9	0.367
ASA			0.285
Ⅰ	12	6
Ⅱ	38	43
Ⅲ	2	3
Preoperative comorbidity			0.395
Presence	14	18
Absence	38	34
Abdominal operation history			0.300
Presence	11	7
Absence	41	45
Tumor size, cm (mean ± SD)	3.4±1.3	3.7±1.0	0.142
Distance of tumor from anal verge, cm (mean ± SD)	14.5±7.5	15.1±8.4	0.703
Tumor location			0.841
Sigmoid colon	21	20
Rectum	31	32
Preoperative serum CEA (ng/mL) (mean ± SD)	4.3±6.3	6.2±8.5	0.186
Preoperative serum CA19-9 (ng/mL) (mean ± SD)	16.3±20.6	16.2±19.5	0.987
Incidence of preoperative CEA elevation	10 (19.2)	17 (32.7)	0.117
Incidence of preoperative CA19-9 elevation	4 (7.7)	4 (7.7)	1.000
Clinical tumor category			0.234
T1	11	5
T2	7	10
T3	34	37
Preoperative chemoradiotherapy	8	10	0.604

Note: NOSE, totally laparoscopic anterior resection with transanal specimen extraction.

Abbreviations: LAP, laparoscopic anterior resection with minilaparotomy; BMI, body mex index; CEA serum carcinoembryonic antigen; CA19–9, carbohydrate antigen 19-9.

Table 2 Operative and postoperative outcomes

Parameter	NOSE (n=52)	LAP (n=52)	p-value
Type of operation, case (%)			1.000
Anterior resection	30 (57.7)	30 (57.7)
Low anterior resection	22 (42.3)	22 (42.3)
Operative time, mins (mean ± SD)	111.2±23.5	110.9±23.6	0.963
Estimated blood loss, mL (mean ± SD)	49.8±48.1	62.5±47.1	0.177
Time to first flatus, day (mean ± SD)	2.8±0.8	3.2±0.9	0.042
Time to Regular diet, day (mean ± SD)	3.9±0.6	4.1±0.9	0.068
Postoperative hospital stay, day (mean ± SD)	9.0±2.0	9.4±3.2	0.380
Post-operative complication, case (%)	4 (7.7)	8 (15.4)	0.358
Anastomotic leakage	1	1
Wound infection	0	2
Haemorrhage requiring transfusion	2	1
Intra-abdominal abscess	1	1
Pulmonary infection	0	1
Urinary retention	0	1
Ileus	0	1
Reoperation, case (%)	0	1 (1.9)
VAS (POD1), (mean ± SD)	4.2±1.4	5.4±1.7	0.003
Additional analgesia required, case (%)	4 (7.7)	13 (25.0)	0.032
Death	0	0
Leukocytosis (POD1), case (%)	40 (76.9)	32 (61.5)	0.089
WBC count difference (POD1), (×10^9)	11.8±2.5	11.6±3.5	0.720
CRP
POD1, mg/dl (mean ± SD)	3.8±3.2	2.3±0.9	0.048
POD3, mg/dl (mean ± SD)	4.8±2.9	9.4±5.9	0.020
POD5, mg/dl (mean ± SD)	1.7±1.9	3.6±3.9	0.153

Note: NOSE, totally laparoscopic anterior resection with transanal specimen extraction.

Abbreviations: LAP, laparoscopic anterior resection with minilaparotomy; VAS, visual analogue scale.

Table 3 Pathological outcomes

Parameter	NOSE (n=52)	LAP (n=52)	p-value
Length of the specimen, cm (mean ± SD)	15.3±5.4	15.5±4.8	0.845
Proximal margin, cm (mean ± SD)	12.2±8.7	11.7±8.1	0.544
Distal margin, cm (mean ± SD)	3.9±1.6	4.3±2.2	0.310
TNM stage			0.409
Ⅰ	16	13
Ⅱ	11	17
Ⅲ	25	22
No. of lymph nodes retrieved (mean ± SD)	19.1±7.0	19.8±8.2	0.609
Histological differentiation			0.263
Well	13	7
Moderate	37	41
Poor	2	4
Perineural invasion	8	7	0.780
Venous invasion	2	4	0.678

Note: NOSE, totally laparoscopic anterior resection with transanal specimen extraction.

Abbreviation: LAP, laparoscopic anterior resection with minilaparotomy.

Table 4 Local and distant recurrence

Case	Group	Gender	Distance of primary tumor from anal verge (cm)	Stage	Time of recurrence	Site of recurrence	Treatment after recurrence
1	NOSE	F	25	T3N0M0	23 months	Anastomosis	Surgery
2	NOSE	M	10	T3N2M0	13 months	Lung	Chemotherapy
3	NOSE	M	10	T3N2M0	18 months	Liver	Radiofrequency ablation
4	NOSE	F	26	T3N0M0	13 months	Local lymph node	Surgery
5	NOSE	M	9	T3N2M0	6 months	Liver	Surgery
6	NOSE	F	20	T3N2M0	36 months	Lung	Chemotherapy
7	NOSE	M	18	T3N2M0	24 months	Liver	Chemotherapy
8	NOSE	M	12	T3N2M0	5 months	Liver and lung	Chemotherapy
9	LAP	M	25	T4N1M0	8 months	Liver	Chemotherapy
10	LAP	M	20	T3N2M0	6 months	Liver	Chemotherapy
11	LAP	M	15	T3N2M0	18 months	Liver	Chemotherapy
12	LAP	F	10	T3N2M0	12 months	Liver	Surgery
13	LAP	F	8	T3N2M0	25 months	Abdominal pelvic cavity	Chemotherapy
14	LAP	F	10	T3N2M0	12 months	Lung	Chemotherapy
15	LAP	M	12	T3N0M0	13 months	Liver	Surgery

Note: NOSE, totally laparoscopic anterior resection with transanal specimen extraction.

Abbreviation: LAP, laparoscopic anterior resection with minilaparotomy.

Figure 1 The overall survival curve clears that 5-year overall survival rate in the NOSE group and LAP group were 92.3% and 94.2%, respectively. There was no significant difference between the NOSE and LAP groups (p=0.985). NOSE, totally laparoscopic anterior resection with transanal specimen extraction; LAP laparoscopic anterior resection with minilaparotomy.

Figure 2 The disease-free survival curve clears that 5-year disease-free survival rate in the NOSE group and LAP group were 84.6% and 86.5%, respectively. There was no significant difference between the NOSE and LAP groups (p=0.802). NOSE, totally laparoscopic anterior resection with transanal specimen extraction; LAP laparoscopic anterior resection with minilaparotomy.