A real world study of 367 cases of colorectal neoplasms treated by natural orifice specimen extraction surgery

doi:10.3877/cma.j.issn.2095-3224.2022.02.003

Abstract

Abstract:

Objective

Analyze the feasibility of natural orifice specimen extraction surgery (NOSES) in colorectal neoplasms by analysising 367 cases of colorectal neoplasms treated by NOSES in our center.

Methods

A total of 367 cases of NOSES were collected. The data of patients included demographic data, surgical data, postoperative pathology and short-term outcomes.

Results

The average age of the patient was (59.7±11.2) years old, and the average BMI of the patient was (22.7±2.9) kg/m². The average operation time was (163.2±52.0) minute, and the average blood loss was 20.0 mL. Patients in stage 0~IV were 7.6%, 29.2%, 35.4%, 25.7% and 2.2% respectively. The proportion of adenocarcinoma was 71.1%, and the number of harvested lymph node was 14.7±4.9. The average postoperative exhausted time was 39.0 hours, and the time of postoperative feeding time was (80.3±44.8) hours, the average of postoperative hospital stay was (8.2±4.2) days, the incidence of complications was 12.0%.

Conclusion

NOSES has promising applications in colorectal neoplasms and is a safe and reliable minimally invasive surgery.

Key words: Colorectal neoplasms, Laparoscopic, Natural orifice specimen extraction surgery (NOSES), Laparoscopic surgery, Minimally invasive surgery

Qingchao Tang, Yihao Zhu, Ziming Yuan, Shuai Jiao, Hanqing Hu, Yuliuming Wang, Tianyi Ma, Tianyu Qiao, Ming Liu, Guiyu Wang, Xishan Wang. A real world study of 367 cases of colorectal neoplasms treated by natural orifice specimen extraction surgery[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2022, 11(02): 108-113.

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References 14

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项目	患者人数	比例（%）
性别
男	168	45.8
女	199	54.2
年龄（岁）
＜60	185	50.4
≥60	182	49.6
BMI（kg/m²）
＜18.5	33	9.0
18.5~23.9	237	64.6
24.0~26.9	75	20.4
27~29.9	20	5.5
≥30.0	2	0.5
伴发疾病
糖尿病	25	6.8
高血压	55	15.0
冠心病	27	7.4
贫血	9	2.5
低蛋白血症	2	0.5
脑血管疾病	5	1.4
肠梗阻	2	0.5
心律失常	2	0.5
其他	38	10.4
无	202	55.0
肿瘤位置
直肠	261	71.1
直乙交界	10	2.7
乙状结肠	72	19.6
降结肠	5	1.4
升结肠	12	3.3
多原发癌	7	1.9
CEA水平（ng/mL）
正常	302	82.3
异常	57	15.5
未查	8	2.2
CA119-9水平（U/mL）
正常	306	83.4
异常	53	14.4
未查	8	2.2

项目	患者人数	比例（%）
性别
男	168	45.8
女	199	54.2
年龄（岁）
＜60	185	50.4
≥60	182	49.6
BMI（kg/m²）
＜18.5	33	9.0
18.5~23.9	237	64.6
24.0~26.9	75	20.4
27~29.9	20	5.5
≥30.0	2	0.5
伴发疾病
糖尿病	25	6.8
高血压	55	15.0
冠心病	27	7.4
贫血	9	2.5
低蛋白血症	2	0.5
脑血管疾病	5	1.4
肠梗阻	2	0.5
心律失常	2	0.5
其他	38	10.4
无	202	55.0
肿瘤位置
直肠	261	71.1
直乙交界	10	2.7
乙状结肠	72	19.6
降结肠	5	1.4
升结肠	12	3.3
多原发癌	7	1.9
CEA水平（ng/mL）
正常	302	82.3
异常	57	15.5
未查	8	2.2
CA119-9水平（U/mL）
正常	306	83.4
异常	53	14.4
未查	8	2.2

项目	患者人数	比例（%）
肿瘤分化程度
高分化	33	9.0
高中分化	30	8.2
中分化	238	64.8
中低分化	23	6.3
低分化	5	1.4
其他	38	10.3
组织分型
腺癌	261	71.1
管状腺癌	37	19.1
黏液腺癌	6	1.6
其他	63	17.2
肿瘤大体分型
浸润型	2	0.5
隆起型	143	39.0
溃疡型	177	48.2
溃疡浸润型	6	1.6
其他	39	10.7
淋巴结检出数目（个）
＜12	100	27.2
≥12	267	72.8
神经侵犯
是	163	44.4
否	204	55.6
血管侵犯
是	93	25.3
否	274	74.7
淋巴管侵犯
是	99	27.0
否	268	73.0
肿瘤环周切缘
阳性	0	0
阴性	367	100.0
肿瘤大小（cm）
＜5	301	82.0
≥5	66	18.0
T分期
Tis	28	7.6
T1	41	11.2
T2	84	22.9
T3	147	40.0
T4	67	18.3
N分期
N0	269	73.3
N1	76	20.7
N2	22	6.0
M分期
M0	359	97.8
M1	8	2.2
AJCC/TNM分期
0期	28	7.6
Ⅰ期	107	29.2
Ⅱ期	130	35.4
Ⅲ期	94	25.6
Ⅳ期	8	2.2

项目	患者人数	比例（%）
肿瘤分化程度
高分化	33	9.0
高中分化	30	8.2
中分化	238	64.8
中低分化	23	6.3
低分化	5	1.4
其他	38	10.3
组织分型
腺癌	261	71.1
管状腺癌	37	19.1
黏液腺癌	6	1.6
其他	63	17.2
肿瘤大体分型
浸润型	2	0.5
隆起型	143	39.0
溃疡型	177	48.2
溃疡浸润型	6	1.6
其他	39	10.7
淋巴结检出数目（个）
＜12	100	27.2
≥12	267	72.8
神经侵犯
是	163	44.4
否	204	55.6
血管侵犯
是	93	25.3
否	274	74.7
淋巴管侵犯
是	99	27.0
否	268	73.0
肿瘤环周切缘
阳性	0	0
阴性	367	100.0
肿瘤大小（cm）
＜5	301	82.0
≥5	66	18.0
T分期
Tis	28	7.6
T1	41	11.2
T2	84	22.9
T3	147	40.0
T4	67	18.3
N分期
N0	269	73.3
N1	76	20.7
N2	22	6.0
M分期
M0	359	97.8
M1	8	2.2
AJCC/TNM分期
0期	28	7.6
Ⅰ期	107	29.2
Ⅱ期	130	35.4
Ⅲ期	94	25.6
Ⅳ期	8	2.2

项目	患者人数/数值	比例（%）
术后排气时间（小时）	39.0
术后进食时间（小时）	80.3±44.8
术后住院天数（天）	8.2±4.2
术后并发症（例）
吻合口漏	13	3.5
切口相关并发症	9	2.5
肠梗阻	8	2.2
肺感染	8	2.2
腹腔感染	4	1.1
其他	2	0.5
二次手术（例）
否	366	99.7
是	1	0.3

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