Robotic natural orifice specimen extraction surgery I-type F method vs conventional robotic resection for lower rectal cancer

Abstract

BACKGROUND

Robotic resection using the natural orifice specimen extraction surgery I-type F method (R-NOSES I-F) is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer. However, the current literature on this method is limited to case reports, and further investigation into its safety and feasibility is warranted.

AIM

To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.

METHODS

From September 2018 to February 2022, 206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis. Of these patients, 22 underwent R-NOSES I-F surgery (R-NOSES I-F group) and 76 underwent conventional robotic-assisted low rectal cancer resection (RLRC group). Clinicopathological data of all patients were collected and analyzed. Postoperative outcomes and prognoses were compared between the two groups. Statistical analysis was performed using SPSS software.

RESULTS

Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1 (1.7 ± 0.7 vs 2.2 ± 0.6, P = 0.003) and shorter postoperative anal venting time (2.7 ± 0.6 vs 3.5 ± 0.7, P < 0.001) than those in the RLRC group. There were no significant differences between the two groups in terms of sex, age, body mass index, tumor size, TNM stage, operative time, intraoperative bleeding, postoperative complications, or inflammatory response (P > 0.05). Postoperative anal and urinary functions, as assessed by Wexner, low anterior resection syndrome, and International Prostate Symptom Scale scores, were similar in both groups (P > 0.05). Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups (P > 0.05).

CONCLUSION

R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer. It improves pain relief, promotes gastrointestinal function recovery, and helps avoid incision-related complications.

Keywords: Robotic surgery; Natural orifice specimen extraction surgery; Lower rectal cancer; Robotic resection using the natural orifice specimen extraction surgery I-type F method

Core Tip: This retrospective study examined the efficacy and safety of a novel surgical procedure called robotic resection using the natural orifice specimen extraction surgery I-type F method (R-NOSES I-F) for lower rectal cancer. Through a comparison with robotic-assisted low rectal cancer resection, the study demonstrates that R-NOSES I-F is a safe and effective minimally invasive surgical approach for low rectal cancer. It offers several benefits, including decreased postoperative pain, improved gastrointestinal function recovery, reduced abdominal wall dysfunction, and avoidance of complications associated with abdominal wall incisions. Furthermore, R-NOSES I-F does not negatively impact anal and urinary functions and does not increase the risk of local recurrence or distant metastasis.