Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7751
Revised: May 13, 2013
Accepted: July 17, 2013
Published online: November 21, 2013
Processing time: 244 Days and 10 Hours
AIM: To investigate whether transanal natural orifice specimen extraction (NOSE) is a better technique for rectal cancer resection.
METHODS: A prospectively designed database of a consecutive series of patients undergoing laparoscopic low anterior resection for rectal cancer with various tumor-node-metastasis classifications from March 2011 to February 2012 at the First Affiliated Hospital of Sun Yat-Sen University was analyzed. Patient selection for transanal specimen extraction and intracorporeal anastomosis was made on the basis of tumor size and distance of rectal lesions from the anal verge. Demographic data, operative parameters, and postoperative outcomes were assessed.
RESULTS: None of the patients was converted to laparotomy. Respectively, there were 16 cases in the low anastomosis and five in the ultralow anastomosis groups. Mean age of the patients was 45.4 years, and mean body mass index was 23.1 kg/m2. Mean distance of the lower edge of the lesion from the anal verge was 8.3 cm. Mean operating time was 132 min, and mean intraoperative blood loss was 84 mL. According to the principle of rectal cancer surgery, we performed D2 lymph node dissection in 13 cases and D3 in eight. Mean lymph nodes harvest was 17.8, and the number of positive lymph nodes was 3.4. Median hospital stay was 6.7 d. No serious postoperative complication occurred except for one anastomotic leakage. All patients remained disease free. Mean Wexner score was 3.7 at 11 mo after the operation.
CONCLUSION: Transanal NOSE for total laparoscopic low/ultralow anterior resection is feasible, safe and oncologically sound. Further studies with long-term outcomes are needed to explore its potential advantages.
Core tip: Natural orifice specimen extraction (NOSE) is an emerging technique that has been recently applied to the field of rectal cancer resection. However, which is the better approach for rectal cancer remains controversial. In this paper, we present our surgical technique and short-term outcomes of transanal NOSE in total laparoscopic low/ultralow anterior resection (L-AR) for patients with rectal cancer. Based on our limited experience, transanal NOSE in L-AR for rectal cancer is feasible, safe and oncologically sound.