3种经自然腔道取标本手术方式治疗直肠癌的安全性与肿瘤学预后对比研究

目的:探讨经自然腔道取标本手术(natural orifice specimen extraction surgery,NOSES)的安全性,并比较3种取标术式在直肠癌治疗中的近期疗效和远期预后.方法:回顾性分析接受腹腔镜NOSES的Ⅰ～Ⅲ期直肠癌患者的临床资料.直肠NOSES手术包括外翻切除式、拉出切除式和切除拖出式...

Comparison of clinical safety and oncological prognosis of three techniques in natural orifice specimen extraction surgery for rectal cancer

Objective:To evaluate the safety of natural orifice specimen extraction surgery(NOSES)and to compare the short-and longterm outcomes of three techniques of NOSES for rectal cancer(RC).Methods:A consecutive series of patients with stageⅠ-ⅢRC who underwent laparoscopic NOSES were enrolled.The three main techniques of NOSES included specimen eversion and extra-abdominal resection(EVER),specimen extraction and extra-abdominal resection(EXER),and intra-abdominal resection and specimen extraction(IREX).The postoperative complication rate,5-year disease-free survival(DFS)rate,5-year local recurrence rate(LRR),and 5-year distant metastasis rate(DMR)were compared among the three techniques.Results:A total of 268 RC patients met the inclusion criteria,including 83 patients treated with EVER,75 patients treated with EXER,and 110 patients treated with IREX.Tumor location was the most critical factor associated with technique selection.The postoperative complication rate was 12.3%in all patients,18.1%for EVER,13.3%for EXER,and 7.3%for IREX(P=0.073).Regarding long-term outcomes,the 5-year DFS,5-year LRR,and 5-year DMR were 85.03%,4.22%,and 11.00%,respectively,in all patients.The 5-year DFS rate was higher in the IREX group than in the other two groups;the 5-year LRR was higher in the EVER group than in the other two groups;and the 5-year DMR was the lowest in the EVER group,but the difference was not statistically significant.Conclusions:The three techniques of NOSES for RC showed acceptable safety and oncological outcomes.Tumor location was a determinant of technique selection.