1. Robotic natural orifice specimen extraction surgery versus robotic transabdominal specimen extraction surgery for early-stage rectal cancer: a multicenter propensity score-matched analysis (in China)
- Author
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Liu, Dongning, He, Guodong, Yao, Hongliang, Guan, Xu, Wang, Guiyu, Xiong, Dehai, Hu, Junhong, Yuan, Weitang, Yang, Chunkang, He, Penghui, Ye, Shanping, Ju, Houqiong, Yu, Hongxin, Niu, Zhengchuan, Liu, Kuijie, Tang, Qingchao, Huang, Rui, Lian, Yugui, Guan, Shen, Jian, Jinliang, Wei, Ye, Wang, Xishan, and Li, Taiyuan
- Abstract
Background: Despite the global increase in the adoption of robotic natural orifice specimen extraction surgery (R-NOSES), its advantages over robotic transabdominal specimen extraction surgery (R-TSES) for treating early-stage rectal cancer remain debated. There is scant nationwide, multicenter studies comparing the surgical quality and short-term outcomes between R-NOSES and R-TSES for this condition. Objective: This retrospective cohort study was conducted nationally across multiple centers to compare the surgical quality and short-term outcomes between R-NOSES and R-TSES in early-stage rectal cancer. Design: Multicenter retrospective cohort trial. Setting: Eight experienced surgeons from 8 high-volume Chinese colorectal cancer treatment centers. Patients: The study included 1086 patients who underwent R-NOSES or R-TSES from October 2015 to November 2023 at the 8 centers. Inclusion criteria were: (1) histologically confirmed rectal adenocarcinoma; (2) robotic total mesorectal excision; (3) postoperative pathological staging of TisN0M0 or T1-2N0M0; (4) availability of complete surgical and postoperative follow-up data. Patients were matched 1:1 in the R-NOSES and R-TSES groups using the propensity score matching (PSM) technique. Results: After PSM, 318 matched pairs with well-balanced patient characteristics were identified. The operation time for the R-NOSES group was significantly longer than that for the R-TSES group [140 min (125–170 min) vs. 140 min (120–160 min), P= 0.032]. Conversely, the times to first flatus and initial oral intake in the R-NOSES group were significantly shorter than those in the R-TSES group [48 h (41–56 h) vs. 48 h (44–62 h), P= 0.049 and 77 h (72–94 h) vs. 82 h (72–96 h), P= 0.008], respectively. Additionally, the length of postoperative hospital stay was shorter in the R-NOSES group compared with the R-TSES group [7 day (7–9 day) vs. 8 day (7–9 day), P= 0.005]. The overall postoperative complication rates were similar between the groups (10.7% in the R-NOSES group vs. 11.9% in the R-TSES group, P= 0.617). However, the R-NOSES group had a lower incidence of wound complications compared to the R-TSES group (0.0% vs. 2.2%, P= 0.015). Regarding surgical stress response, the R-NOSES group showed superior outcomes. Additionally, patients in the R-NOSES group required fewer additional analgesics on postoperative days 1, 3, and 5 and reported lower pain scores compared to the R-TSES group. The body image scale (BIS) and cosmetic scale (CS) scores were also significantly higher in the R-NOSES group. Furthermore, the R-NOSES group demonstrated significantly better outcomes in functional dimensions such as physical, role, emotional, social, and cognitive functioning, and in symptoms like fatigue and pain, when compared to the R-TSES group. Limitations: It is imperative to ensure the safe and standardized implementation of R-NOSES through the establishment of a uniform training protocol. Conclusions: These results affirm that R-NOSES is a safe and effective treatment for early-stage rectal cancer when meticulously executed by skilled surgeons.
- Published
- 2024
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