A prospective study of recent bacteriological and oncological significance after NOSES for robotic rectal cancer

doi:10.3877/cma.j.issn.2095-3224.2023.04.003

Abstract

Abstract:

Objective

To investigate the aseptic and tumor free effect of robot assisted radical resection of rectal cancer by natural origin specific extraction surgery (R-NOSES), and analyze its short-term clinical efficacy.

Methods

The clinical data of 66 patients with rectal cancer who visited the General Surgery Department of the First Affiliated Hospital of Nanchang University from May 2020 to March 2021 were prospectively included. After exclusion and withdrawal criteria, sixty-three patients were successfully enrolled, including 32 patients with robot assisted radical resection of rectal cancer (R-S) and 31 patients with R-NOSES. By comparing the perioperative clinicopathological data, bacteriological and oncological results of the two groups of patients, the aseptic and tumor free effect and short-term clinical efficacy of robot assisted radical resection of rectal cancer through natural cavity were analyzed.

Results

In terms of postoperative bacteriology, there was no significant difference in the positive rate of bacterial culture of peritoneal washings between the R-NOSES group and the R-S group (12.90% vs.6.25%, χ²=0.131, P＞0.05), and the oncological detection of peritoneal washings in both groups was negative. Compared with R-S group, R-NOSES group had less intraoperative bleeding (43.67±20.08 vs.62.36±29.01, t=-4.237, P＜0.05) and lower VAS pain score on the first day after operation (3.83±0.75 vs.4.97±0.73, t=-7.342, P＜0.001). The VAS pain score was lower on the third day after operation (1.90±0.85 vs.2.93±0.96, t=-5.352, P＜0.001). There was no significant difference between the two groups in terms of operation time, postoperative exhaust time, postoperative first fluid intake time, postoperative catheter removal time, postoperative drainage tube removal time, postoperative hospital stay and postoperative complication rate (P＞0.05).

Conclusion

The results of oncology and bacteriology in R-NOSES group are similar to those in R-S group, and R-NOSES operation has less intraoperative bleeding, less pain, and more obvious minimally invasive advantages.

Key words: Rectal neoplasms, Natural orifice specimen extraction surgery, Da Vinci robotic surgery system, Bacteriology, Oncology

Weiquan Zhu, Shanping Ye, Hechun Tang, Dongning Liu, Houqiong Ju, Chonghan Zhong, Zhixiang Huang, Taiyuan Li. A prospective study of recent bacteriological and oncological significance after NOSES for robotic rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(04): 282-287.

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References 24

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组别	例数	性别		年龄（岁）	BMI	ASA			术前CEA		CA19-9		术前T分期
组别	例数	男	女	年龄（岁）	BMI	Ⅰ	Ⅱ	Ⅲ	升高	正常	升高	正常	T1	T2	T3
R-NOSES组	31	19	12	57.48±8.56	22.16±2.52	11	16	4	27	4	28	3	10	17	4
R-S组	32	23	9	61.34±10.72	22.79±2.39	9	18	5	26	6	28	4	7	19	6
t/χ²值		0.794		-1.576	-1.006	0.413			0.403		0.127		0.132
P值		0.373		0.12	0.318	0.813			0.525		0.822		0.599

组别	例数	性别		年龄（岁）	BMI	ASA			术前CEA		CA19-9		术前T分期
组别	例数	男	女	年龄（岁）	BMI	Ⅰ	Ⅱ	Ⅲ	升高	正常	升高	正常	T1	T2	T3
R-NOSES组	31	19	12	57.48±8.56	22.16±2.52	11	16	4	27	4	28	3	10	17	4
R-S组	32	23	9	61.34±10.72	22.79±2.39	9	18	5	26	6	28	4	7	19	6
t/χ²值		0.794		-1.576	-1.006	0.413			0.403		0.127		0.132
P值		0.373		0.12	0.318	0.813			0.525		0.822		0.599

组别	手术出血量（mL）	手术时间（min）	术后排气时间（h）	首次进流质时间（h）	术后住院时间（d）	术后拔除尿管时间（d）	术后拔除引流管时间（d）	术后VAS评分
组别	手术出血量（mL）	手术时间（min）	术后排气时间（h）	首次进流质时间（h）	术后住院时间（d）	术后拔除尿管时间（d）	术后拔除引流管时间（d）	1	3	5
R-NOSES组	43.67±20.08	153.87±19.61	38.67±8.52	55.53±11.36	8.3±3.13	4.60±0.72	7.43±2.87	3.83±0.75	1.90±0.85	1.70±0.70
R-S组	62.36±29.01	154.69±16.16	42.55±8.47	59.03±11.97	8.93±4.51	4.52±0.79	8±4	4.97±0.73	2.93±0.96	1.69±0.66
t/χ²值	-4.237	1.402	-1.075	-0.905	-2.342	-3.342	-1.312	-7.342	-5.352	2.521
P值	＜0.05	0.857	0.053	0.382	0.112	0.693	0.068	<0.001	<0.001	0.685

组别	手术出血量（mL）	手术时间（min）	术后排气时间（h）	首次进流质时间（h）	术后住院时间（d）	术后拔除尿管时间（d）	术后拔除引流管时间（d）	术后VAS评分
组别	手术出血量（mL）	手术时间（min）	术后排气时间（h）	首次进流质时间（h）	术后住院时间（d）	术后拔除尿管时间（d）	术后拔除引流管时间（d）	1	3	5
R-NOSES组	43.67±20.08	153.87±19.61	38.67±8.52	55.53±11.36	8.3±3.13	4.60±0.72	7.43±2.87	3.83±0.75	1.90±0.85	1.70±0.70
R-S组	62.36±29.01	154.69±16.16	42.55±8.47	59.03±11.97	8.93±4.51	4.52±0.79	8±4	4.97±0.73	2.93±0.96	1.69±0.66
t/χ²值	-4.237	1.402	-1.075	-0.905	-2.342	-3.342	-1.312	-7.342	-5.352	2.521
P值	＜0.05	0.857	0.053	0.382	0.112	0.693	0.068	<0.001	<0.001	0.685

组别	肿瘤大小（cm）	清扫淋巴结数目（枚）	阳性淋巴结数目（枚）	TNM分期			脉管侵犯		神经侵犯
组别	肿瘤大小（cm）	清扫淋巴结数目（枚）	阳性淋巴结数目（枚）	Ⅰ	Ⅱ	Ⅲ	阳性	阴性	阳性	阴性
R-NOSES组	2.99±0.95	10.26±4.55	3.30±1.66	8	10	13	3	28	1	30
R-S组	3.30±1.66	12.06±4.09	0.34±0.87	9	8	15	4	28	2	30
t/χ²值	-1.752	0.215	0.842	0.409			0.127		0.31
P值	0.583	0.103	0.331	0.815			0.822		0.573

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